Evidence Checklist: Osteoporosis

DEXA scan (dual-energy X-ray absorptiometry) with T-score resultsCritical

Bone mineral density results from DEXA scan documenting T-scores at the lumbar spine, femoral neck, and/or total hip. T-score of -2.5 or below confirms osteoporosis; -1.0 to -2.5 indicates osteopenia.

Nexus opinion linking osteoporosis to service-connected condition or medication ("at least as likely as not")Critical

A medical opinion connecting osteoporosis to a service-connected condition (e.g., hypogonadism from TBI, malnutrition, PTSD medications such as long-term steroids) or establishing it as secondary to a primary service-connected disease.

Laboratory workup (calcium, vitamin D, PTH, testosterone/estradiol)

Lab results evaluating secondary causes of osteoporosis including calcium, 25-OH vitamin D, parathyroid hormone, and sex hormone levels.

Documentation of osteoporotic fractures (vertebral, hip, wrist)Critical

Records of fragility fractures attributable to osteoporosis, including vertebral compression fractures on spine imaging, hip fractures, or distal radius fractures that occurred with minimal trauma.

Documentation of bone-active medications (bisphosphonates, teriparatide)

Records showing prescription of bone-strengthening medications and the rationale for treatment, reflecting the severity of the condition.

Buddy statement from spouse, family, or fellow service member

A written statement from someone who can describe observable symptoms and how your condition affects daily life.

Personal statement describing symptoms and functional impact

Your own written account of how this condition affects your daily activities, work, and relationships. Describe your worst days.

Completed DBQ Musculoskeletal ConditionsCritical

Standardized form capturing bone density findings, fracture history, and functional limitations. Rate under the most limiting fracture or musculoskeletal manifestation.

Service treatment records (STRs)Critical

Military medical records showing in-service treatment, complaints, or injuries related to this condition.