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DIAGNOSIS
Osteoporosis develops gradually, usually without symptoms. A broken bone that occurs with minor trauma, such as a slight blow to the wrist, for example, is typically the first symptom.
Of the 1.3 million broken bones attributable to osteoporosis that Americans experience each year, nearly half are fractures in the spine, called vertebral compression fractures. These occur when weakened vertebrae suffer the impact of a strain, bump or fall. Vertebral compression fractures can lead to loss of height, severe and sometimes chronic pain, crowding of internal organs and stooped posture (called kyphosis or "dowager's hump"). They can also result in prolonged disability and increased mortality.
Hip fractures are another common consequence of osteoporosis, accounting for one-quarter of osteoporosis-related breaks. A hip fracture can lead to a downward spiral of declining health, decreased mobility and increased frailty. They almost always require hospitalization and major surgery, and may require long-term nursing home care.
For some, this injury may cause prolonged or permanent disability or even death. Due to the aging U.S. population, the number of hip fractures could double or even triple by the year 2020, according to U.S. Surgeon General's 2004 Report on Osteoporosis and Bone Health.
Your health care professional can make a diagnosis of osteoporosis based on your medical history with an assessment of your risk factors; a physical examination and laboratory tests; and a bone mineral density (BMD) test, a non-invasive test that measures your bone mass.
Common risk factors for osteoporosis are:
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Small, thin frame (weighing less than 127 pounds)
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Personal and/or family history of broken bones or stooped posture in adulthood
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Previous history of osteoporotic fractures of the spine, hip or wrist
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Low lifetime intake of calcium
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Excessive thinness
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Smoking
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Excessive alcohol consumption ("Moderate drinking" levels for women and older people is defined by the National Institute on Alcohol Abuse and Alcoholism as one drink per day—one drink equals: 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits—are considered safe)
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Inactive lifestyle
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Estrogen deficiency caused by menopause and certain medical conditions such as polycystic ovarian syndrome and anorexia nervosa
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Absence of menstrual periods or irregular menses as a young woman
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Long-term use of some anticonvulsants and corticosteroids (glucocorticoids are a significant contributor to osteoporosis, according to the U.S. Surgeon General's 2004 Report on Osteoporosis and Bone Health).
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Caucasian or Asian ethnic backgrounds, but African-Americans and Hispanic Americans are also at significant risk. According to the Surgeon General's 2004 report, there is some evidence that rates are on the rise among Hispanic women.
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Certain chronic medical conditions including diabetes, hyperthyroidism, some hyperparathyroidism, some bowel diseases and rheumatoid arthritis
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Depression. Research sponsored by the National Institute of Mental Health suggests that depression may also be a major risk factor for osteoporosis. A clinical trial is currently underway to determine whether women with major depression lose bone mass at a faster rate than women without depression. This study will also determine if the drug alendronate (Fosamax) can maintain or increase bone mass in women ages 21 to 45 with major depression and osteoporosis.
Next Steps
After discussing your individual concerns about osteoporosis with your health care professional, a series of laboratory tests may be recommended. These tests will help identify or rule out conditions other than menopause that may be causing low bone density. They include:
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Complete blood cell count
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Serum chemistry studies
If your medical history or physical findings suggest causes of bone loss other than menopause and age, then additional laboratory tests may be conducted.
The U.S. Preventive Services Task Force recommends that women age 65 and older be routinely screened for osteoporosis and that routine screening begin at age 60 for those women identified at high risk for the condition. In addition, the U.S. Surgeon General's 2004 Report on Bone Health and Osteoporosis recommends bone mineral density (BMD) testing for osteoporosis in women younger than 65 who have multiple risk factors for the disease, men and women with fractures caused by weak bones or who have other diseases or take medications that can greatly increase the risk of fracture.
It is recommended to have your BMD performed at a hospital or special osteoporosis center that does bone density testing on a regular basis.
There are several types of BMD tests. They fall into two categories: Central machines measure bone density in the hip, spine and total body, while peripheral machines measure density in the finger, wrist, kneecap, shin bone and heel. Bone mineral density tests include:
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DEXA (Dual Energy X-ray Absorptiometry) measures bone density at the spine, hip or total body
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SXA (Single Energy X-ray Absorptiometry) measures bone density at the wrist or heel
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pDXA (Peripheral Dual Energy X-ray Absorptiometry) measures bone density at the wrist, heel or finger
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RA (Radiographic Absorptiometry) uses an x-ray of the hand and a small metal wedge to calculate bone density.
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QCT (Quantitative Computed Tomography) most commonly used to measure spine; can also be used at other sites.
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pQCT (Peripheral Quantitative Computed Tomography) measures bone density at the wrist.
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Ultrasound uses sound waves to measure bone density at the heel, shin bone and kneecap
Results of BMD tests are usually expressed as "T-scores," a measure of how far your bone density deviates above or below the average bone density value for a young, healthy, Caucasian woman.
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A T-score between +1 and —1 indicates normal bone density.
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A T-score at or below -2.5 usually signals osteoporosis. A T-score between -1 and -2.5 usually signals osteopenia, or low bone density.
Your bone density is also compared to an "age matched" standard. The age-matched reading (Z-score) compares your bone density to the "norm" for your age, sex and size.
Your T-score will help your health care professional determine whether you are at risk for a fracture. Generally, the lower your bone density, the higher your risk for fracture. However, your health care professional will consider your BMD score along with your personal health history, osteoporosis risks and lifestyle, including whether you exercise and are getting adequate calcium. By weighing all of these factors, your health care professional can determine if osteoporosis poses a significant threat for you now or in the years ahead.
Some tests for osteoporosis risk, such as those available at community health fairs, provide a starting point for assessing your bone health—but definitely require follow-up. If you have one of these types of tests, be sure to discuss the results with your health care professional, especially if your results indicate low bone density.
Medicare and most commercial insurers pay for BMD testing for individuals at risk or already suffering from osteoporosis.
