Osteoporosis does not hurt until something breaks. The agencies say so plainly.
“Osteoporosis is called a 'silent' disease because there are usually no symptoms until a bone breaks.”
— US National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), osteoporosis
Which means “I'll go when it starts hurting” does not work here. This article answers three things. When to get tested, how to read the report, and what actually helps. Screening eligibility comes from Korea's National Health Insurance Service; the rest from NIAMS, the NIH Office of Dietary Supplements and Korea's Disease Control agency.
When the national programme tests you — women at 54, 60 and 66
Korea's National Health Insurance Service screening table sets it out like this.
Bone density testing — “women aged 54, 60 and 66”
The note column gives the reason: “60-year-old women added for the prevention and management of osteoporosis.”
— National Health Insurance Service, general health screening — tests by sex and age
The age of 60 is a recent addition. A 2022 Service publication listed only 54 and 66, so the twelve-year gap between tests has now been halved.
Set beside the other items, though, bone density remains narrow.
| Test by sex and age | Who | What the note column says |
|---|---|---|
| Bone density | Women aged 54, 60 and 66 | “60-year-old women added for the prevention and management of osteoporosis” |
| Dyslipidaemia | Men from 24, women from 40 — every four years | Men at 24, 28, 32… / women at 40, 44, 48… |
| Hepatitis B | Age 40 | Excludes those immune or carrying the virus |
| Hepatitis C (antibody) | Age 56 | “Newly introduced for hepatitis prevention” |
| Cognitive impairment | 66 and over — every two years | 66, 68, 70… |
| Mental health — depression | 20–34 (every two years) · 35–39 (once) · 40s–70s (once per decade) | “Interval shortened for the 20–34 group as mental health risk rises” |
Dyslipidaemia repeats every four years from 24 for men and 40 for women, while bone density comes up three times in a lifetime — and only for women.
So there are situations that call for a test before the eligible age. Korea's Disease Control agency writes that “as oestrogen production declines, the risk of osteopenia and osteoporosis rises sharply from the menopausal transition, so bone density should be assessed at this stage” with specialist advice. That reads as earlier than the programme's 54.
Whether you are eligible this year is on the screening notice the Service sends out. The other numbers on the report are covered in reading your results sheet.
Read the letter before the number — T or Z
A bone-density report comes back with a score, but not everyone receives the same kind of score.
“A T-score is the difference between your bone density and 0, which is the bone density of a healthy young adult.”
“A Z-score is the difference between your bone density and the average bone density of healthy people your age, race and sex.”
“If you are a premenopausal woman or a man under 50, your bone density test result will be a Z-score.”
— NIAMS, bone mineral density tests — what the numbers mean
| Score | Compared against | Whose report shows it |
|---|---|---|
| T-score | A healthy young adult's bone density | Postmenopausal women, men 50 and over |
| Z-score | The average for the same age, race and sex | Premenopausal women, men under 50, children |
Here is how it plays out. A 45-year-old woman gets “−1.8” at a health check, searches online, finds “below −1.0 is osteopenia” and takes fright. But if that number is a Z-score, it is measured against the average for her own age, and the comparison is entirely different. Holding a T-score threshold against a Z-score is measuring with the wrong ruler.
The report always states which one it is. Read that before the number.
Does this apply to me? Osteopenia is near-identical by sex
Korean figures cited by the Disease Control agency, and the table is not what most people expect.
| Aged 50 and over | Osteoporosis | Osteopenia |
|---|---|---|
| Women | 37.3% | 48.9% |
| Men | 7.5% | 46.8% |
On osteoporosis alone, 37.3% against 7.5% reads as a women's issue. On osteopenia it is 48.9% against 46.8% — practically the same. The published wording is that “in men osteoporosis prevalence is a fifth of that in women, but osteopenia prevalence is similar.”
So bone thinning is common to both sexes; women simply cross into osteoporosis more often. Which is why this article sits under women's health but reads the same way for men.
Age is not the only factor.
| Risk factors for losing bone mass |
|---|
| Older age · female sex · low body weight |
| Smoking · alcohol |
| Family history |
| Co-existing conditions — rheumatoid arthritis, diabetes, hyperthyroidism, chronic liver disease |
| Medications — steroids among others |
Hyperthyroidism and steroids on that list are worth noting. Anyone on long-term steroids has reason to raise it with a doctor regardless of the screening age.
Conversely, getting tested because something aches points the wrong way. Asked whether aching joints should raise suspicion of osteopenia, the agency answers that “osteopenia has no particular symptoms until a fracture occurs,” redirecting pain toward menopausal symptoms, osteoarthritis or rheumatic disease. Bone density is measured when nothing hurts.
Left alone — a cough can break a bone
Osteoporotic fractures are not evenly distributed; they concentrate.
| Item | NIAMS wording |
|---|---|
| Where fractures occur | “can happen in any bone but most often occur in the hip, vertebrae in the spine, and wrist” |
| What causes them | Not only minor falls but bending over, lifting, or coughing |
| A broken vertebra | Severe back pain, loss of height, a stooped posture |
| Who is most affected | “postmenopausal women and men over 70” |
“Coughing” appearing on that list tells you what kind of disease this is: falling is not a prerequisite. And because a broken hip means a long period off your feet, this is as much a question of preventing falls as of bone.
What helps — strength training before walking
Walking comes to mind first, but it is not what NIAMS puts at the top.
“Studies show that the best physical activity for your bones is strength training or resistance training.”
— NIAMS, osteoporosis — diagnosis, treatment and steps to take
| Step | Detail |
|---|---|
| Strength and resistance work | Named as the best activity for bone |
| If you already have osteoporosis | Avoid high-impact exercise; focus on strength, balance and fall prevention |
| Calcium and vitamin D | The amounts by age below |
| Around the house | Clear the floor, non-slip shoes, bathroom grab rails, better lighting, secure the rugs |
| Not smoking, less alcohol | Both appear on the risk factor list |
If exercise volume is hard to judge, see the comparison of official activity guidelines. Aerobic targets vary by agency, but strength work is twice a week everywhere.
Calcium and vitamin D requirements split by age and sex. Two NIH-affiliated sources put side by side did not disagree.
| Group | Calcium — NIAMS | Calcium — ODS | Vitamin D |
|---|---|---|---|
| Adults 19–50 | 1,000mg | 1,000mg | 600IU (15mcg) |
| Women 51–70 | 1,200mg | 1,200mg | 600IU (15mcg) |
| Men 51–70 | — | 1,000mg | 600IU (15mcg) |
| 71 and over | 1,200mg | 1,200mg | 800IU (20mcg) |
| Vitamin D upper limit | — | 4,000IU (100mcg) | |
One row stands out: past 51 the figure rises to 1,200mg for women while men stay at 1,000mg. Menopause is what separates them at the same age.
For food, milk, yoghurt and cheese, tinned sardines and salmon eaten with the bones, kale, broccoli and cabbage supply calcium; oily fish such as salmon and trout are the best vitamin D source. Sunlight produces it too, though cloud, smog, older age and darker skin all reduce how much.
Calcium blocks thyroid medication
The interaction section is the part most often skipped on a supplement page.
Medicines calcium supplements can affect — “levothyroxine (thyroid hormone), quinolone antibiotics, lithium, dolutegravir”
— NIH Office of Dietary Supplements, calcium
Levothyroxine is the most commonly prescribed drug for hypothyroidism. Plenty of people on thyroid medication start calcium for their bones, and swallowing both at the same time can reduce how much of the drug is absorbed.
Read that alongside the risk factor list above, where hyperthyroidism appears — the thyroid is a bone risk factor before it is an absorption problem. How to space the doses is a question for whoever prescribed them; the thyroid side is covered in thyroid warning signs.
Questions people ask
Is −1.8 on my report dangerous?
Check whether it is a T-score or a Z-score first. Premenopausal women receive a Z-score, measured against the average for their own age, which means online T-score thresholds do not apply. The verdict is in the wording printed alongside (normal, osteopenia, osteoporosis).
Isn't a T-score of −2.5 osteoporosis?
It is a widely used threshold, but the NIAMS pages we read do not contain that number. They explain what each score compares against and stop short of the cut-offs, so no figure appears here either.
Do men need to think about this?
For osteopenia, yes. Past 50 it runs 48.9% in women against 46.8% in men. NIAMS also names “men over 70” as particularly affected. But the national bone-density test covers women only, so men with risk factors need to raise it at a consultation.
Is a calcium supplement enough?
Calcium and vitamin D carry separate requirements, and what NIAMS names as best for bone is not a supplement but strength training. The three do not substitute for one another.
Can sunlight alone cover vitamin D?
Korea's Disease Control agency suggests “15 minutes outdoors between noon and 2pm with arms and legs exposed,” while attaching conditions: “sunlight through a window indoors, or being outdoors clothed and wearing sunscreen, does not produce vitamin D in the skin properly.” The same answer adds that “because modern life is largely indoors… oral vitamin D supplementation is often necessary.”
My joints ache — is it osteoporosis?
That points the wrong way. Osteopenia has no symptoms before a fracture. Pain suggests menopausal symptoms, osteoarthritis or something else worth investigating on its own, while bone density is measured when nothing hurts.
Sources
- Korea National Health Insurance Service — general health screening guidance (checked August 2026). Source for bone density testing at 54, 60 and 66 for women and the note “60-year-old women added for the prevention and management of osteoporosis,” dyslipidaemia from 24 for men and 40 for women every four years, hepatitis B at 40, hepatitis C at 56 with “newly introduced for hepatitis prevention,” cognitive screening from 66 every two years, and the mental health intervals. A 2022 Service publication listed only ages 54 and 66.
- NIAMS — bone mineral density tests — what the numbers mean. Source for the definitions of the T-score and Z-score and for “if you are a premenopausal woman or a man under 50, your result will be a Z-score.”
- NIAMS — osteoporosis and diagnosis, treatment and steps to take. Source for “a silent disease — usually no symptoms until a bone breaks,” the fracture sites, fractures from bending, lifting and coughing, the signs of a vertebral fracture, “postmenopausal women and men over 70,” the calcium and vitamin D tables, “the best physical activity for your bones is strength or resistance training,” the exercise cautions with established osteoporosis, and the household fall-prevention list.
- NIH Office of Dietary Supplements — calcium and vitamin D. Source for the amounts by life stage, the 4,000IU vitamin D upper limit, the statement that inadequate calcium leads to osteoporosis, the food sources, the interactions with levothyroxine and quinolone antibiotics, and the note that cloud, smog, older age and darker skin reduce cutaneous production.
- Korea Disease Control and Prevention Agency — National Health Information Portal, osteopenia. Source for prevalence past 50 (women 37.3% osteoporosis and 48.9% osteopenia; men 7.5% and 46.8%) and for “in men osteoporosis prevalence is a fifth of that in women, but osteopenia prevalence is similar” (citing the Korean Society for Bone and Mineral Research fact sheet, 2019), for “no particular symptoms until a fracture occurs,” the risk factor list, “risk rises sharply from the menopausal transition,” and the conditions for cutaneous vitamin D synthesis.
- What we read into it. “Adding 60 halves the twelve-year gap” is our own arithmetic and is not how the Service presents it, as is the contrast between three bone-density tests in a lifetime and dyslipidaemia every four years, which comes from reading several rows of the screening table together. The Korean prevalence figures are a 2019 society publication cited by an agency page, and we did not check the primary source. The calcium and vitamin D amounts are US figures and were not compared against Korean recommended intakes.
Where to check further
This article goes as far as the agency material allows. The rest is best looked at here.
- Whether you are eligible this year — checked here, on the Service’s screening guidance. The table above comes from the screening guidance the Service distributes; the underlying regulatory schedule would not open.
- The verdict on your own report — read the wording printed with it. NIAMS explains what the scores compare against but publishes no cut-off figures, so none appear here. Past reports can be retrieved through Government24’s screening-results service.
- Worried but not yet of screening age — discuss it at a consultation. Risk rises sharply from the menopausal transition, and factors such as long-term steroids or family history matter regardless of age. The Korean material splits across osteoporosis and osteopenia on the national health information portal — they are two separate documents.
As of August 2026. Screening eligibility comes from the National Health Insurance Service, score interpretation and the exercise and nutrient figures from NIAMS and the ODS, and Korean prevalence and risk factors from the Disease Control agency. For the wider changes around menopause see the menopause transition; if unexplained fatigue overlaps, see iron deficiency anaemia. This is general health information and does not substitute for medical diagnosis or treatment. Bone density and fracture risk vary widely between individuals — speak to a specialist.
