The Diagnosis of Osteoporosis

Osteoporosis is a chronic bone condition in which a loss of bone mass density results in low trauma or low impact fractures. In other words, with very little pressure or contact, an individual can have a bone fracture that requires medical attention. Unfortunately, although most bone fractures are not life threatening, individuals who suffer from a bone fracture as a result of osteoporosis have a risk of up to 20% of dying within the first year. (1)

The diagnosis of osteoporosis is essential in order to begin adequate treatment and preventative measures to decrease bone mass density loss. Physicians will use a DXA, or Dual Energy X-ray Absorptionmetry, which is considered the gold standard for diagnosis of osteoporosis. (2)

This test evaluates the bone mineral density and compares it to a reference sample for any person of the same gender and the same age. The value must be less than or equal to 2.5 standard deviations below that of the reference sample. This number is translated into a T-score. The World Health Organization has established diagnostic guidelines for the T. score and believes that a score that is 1.0 or greater is considered normal, between 1.0 and 2.5 is low bone mass and 2.5 or below is the criteria for the diagnosis of osteoporosis. (3,4)

Many individuals are not diagnosed with osteoporosis until they have already had a fracture. Unfortunately, those who have suffered a bone fracture are four times more likely to have another one as another person of the same age and bone density who has not yet suffered a bone fracture. The diagnostic term for an individual who has suffered a fracture as a result of a low trauma event is \”severe or established osteoporosis\”.

Another tool a physician may use in the diagnosis of osteoporosis is urine or serum NTx. This is a measurement of a byproduct of bone and cartilage breakdown which can occur in the blood or urine. The value will represent a dynamic measure of bone re-absorption. This test can be done easily in the office, or at the lab, and the results are usually ready within five minutes. A urine score of greater than 40 may indicate that the individual suffers from osteoporosis. (5)

The physician will also do a thorough physical examination of the individual as well as an extensive medical history. The physical exam will begin with an inspection and accurate height measurements. This accurate height measurement will be done using a stadiometer, which is an electric measurement tool using electronic capacitor sensors.

Some women will present with a dowager\’s hump, which results from compression fractures in the spint and as a thoracic kyphosis or exaggerated cervical lordosis. After each compression fracture, an individual’s height can decrease by as much as two to 3 cm.

During a physical examination the physician will percuss the spinal processes (tap on the spinal processes in the back), which is helpful diagnosing acute or subacute vertebral compression fractures. During this examination they will also look for passive range of motion to determine whether the spine, hip, wrist or other bony pathology may be present. Doctors will also attempt to rule out spinal or peripheral nerve compromise through a neurological examination.

During the diagnosis process doctors must rule out primary osteoporosis versus secondary osteoporosis. Individuals who suffer from primary osteoporosis are usually postmenopausal women year regardless of age while secondary osteoporosis happens to individuals from another disease states such as genetic, hormonal or inflammatory processes which impact either the manufacture or breakdown of bone cells.

As in the other disease processes early diagnoses will allow earlier treatment and preventative measures that can decrease the risk of an individual sustaining fractures. It will also prevent frailty which is the primary reason older adults live out their latter years in a nursing home.

(1) Garvan Institute: Bone Fractures Can Double or Triple Mortality for up to 10 Years

(2) National Osteoporosis Foundation: Understanding Osteoporosis

(3) RadiologyInfo.org: Bone Density Scan

(4) The Cleveland Clinic: DXA Scanning to Diagnose Osteoporosis: Do You Know What the Results Mean?

(5) Clinical Chemistry: Evidence that Serum NTx Can Act as an Immunochemical marker of Bone Resorption