How is osteoporosis diagnosed?

A doctor will review a patient’s personal and family medical history and conduct a physical examination. A physical exam will allow for the doctor to examine the curve of the spine and check for the presence of a “dowager’s hump”.

Some of the additional tests that are conducted include:

• X-rays – These will show the density of the bones through using electromagnetic energy beams.
• Bone densitometry (bone density test) / Bone Mineral Density (BMD) – Bone Mineral Density (BMD) refers to the measurement of calcium levels in the bones, and is used to estimate the risk of fractures occurring. BMD can also determine whether a person has osteoporosis or osteopenia (this is the thinning of bone mass in people who do not have osteoporosis).
  
  These tests measure the mass of the bones in relation to their volume and can also determine one’s risk of developing osteoporosis. They are similar to X-rays and are conducted quickly and painlessly. Bone density tests are often used to detect the presence of osteoporosis when the condition is still mild and before the development of fractures occurs. This detection often leads to treatment that will prevent the disease from progressing. These tests also serve as a baseline for treatment as they are able to be utilised to monitor a patient’s response to treatment. A BMD test will measure the bone density in your wrist, lower arm, hell or finger.
  
  In those suffering from a loss of height or who have any suspicious fractures, a bone density test will be able to confirm a diagnosis of osteoporosis.
  
  
  Types of bone density tests include:
  
  
  • DEXA (dual-energy X-ray absorptiometry) – This is an extremely accurate bone density test and as such, is the most widely recognised and used form of examination. This test will typically take 10 to 15 minutes to complete and is completely painless. A DEXA uses very minimal amounts of radiation and is usually conducted on the hip and spine.
  • Ultrasound bone density – This is a new kind of test used to measure bone density of the heel. This test is quicker and often less expensive than DEXA, however, a number of medical professionals do not accept it as being accurate enough to be used in the diagnosis and/or monitoring of osteoporosis as the results do not accurately compare to bone density measurements in other tests.
• Blood tests – These are often conducted to measure the levels of potassium and calcium in the blood.
• Urine tests - These are conducted to determine if there is a specific underlying cause of osteoporosis, for example, a thyroid issue.

**My Med Memo - Both blood and urine tests are able to detect specific underlying causes of osteoporosis, however, most people do not have a clear cause of the condition present apart from being postmenopausal (older women) or of an advanced age.

• FRAX score – This is a score that estimates the risk of getting a fracture within the next ten years. It is determined based on the results of a bone density test and a number of other factors.

Due to women having a higher risk of osteoporosis in comparison to men, they are encouraged to:

• Review their lifestyle practices and potential risk factors with their doctor on a regular basis
• Have any injuries due to falls examined immediately and personal risk factors assessed and/or checked annually after they have gone through menopause
• Get checked if any back and/or spine pain is experienced and have their posture examined
• Have their weight and height checked annually

Understanding BMD (bone density) test results

Bear in mind that no bone density test is 100% accurate, however, these tests are vital predictors for fractures occurring in the future.

Your bone density test results will be reported using T-scores. This score will show how much your bone density is lower or higher than that of a healthy 30-year old person. Your doctor will look at your lowest T-score in order to determine the diagnosis of your condition.

If you are given a score of 0, this will mean that your BMD is on par to that of a healthy adult. The differences between your bone density results and those of a healthy adult will be measured in units known as SDs (standard deviations). If you have more SDs below 0, which will be shown as negative figures, then the lower your BMD is and the higher your fracture risk is. Basically, the bigger your negative number is, the more severe your osteoporosis is.

Have a look at the information below to gain an understanding on T-scores: 

• Normal level = This means that your bone density falls within 1 SD (positive 1 or negative 1) compared to a healthy adult.
• Low bone mass = This refers to a bone density that is between 1 and 2.5 SD (negative 1 to negative -2.5) lower than that of a healthy adult.
• Osteoporosis = You will be diagnosed with osteoporosis if your bone density is 2.5 SD or more below that of a healthy adult (meaning it is negative 2.5 or lower)
• Severe (also known as established) osteoporosis = This will be diagnosed if your bone density is more than 2.5 SD below a healthy adult mean and you have had one or more fractures associated with osteoporosis.

The difference between a low bone mass and osteoporosis

The information that is provided by your bone density test will allow for your doctor to decide whether he or she should prevent or treat your condition.

Should you have a bone mass that is low, but not low enough to be diagnosed as osteoporosis, then your doctor may refer to this as osteopenia. Not everyone who has a low bone mass will get osteoporosis, however, if you have a low bone mass this does increase your chances of the condition developing.

Who should have bone density testing?

Guidelines set out by the National Osteoporosis Foundation identify a number of different risk groups that should undergo DEXA testing to determine bone health. These groups include:

• All women who are 65 and older
• All women who are postmenopausal and are under the age of 65 with risk factors of osteoporosis present.
• Women who are postmenopausal and have bone fractures – bear in mind, this is not a mandatory requirement as treatment for osteoporosis may be initiated regardless of the person’s bone density.
• Women who have one of the medical conditions associated with osteoporosis. These include:
  • Gastrointestinal and digestive disorders
  • Autoimmune disorders
  • Medical procedures
  • Blood/hematologic disorders
  • Nervous system/neurological disorders
  • Hormonal/Endocrine disorders
  • Bone marrow and blood disorders

The guidelines set out by the National Osteoporosis Foundation mention that bone-density testing need not be conducted if one has a known fracture linked to osteoporosis (known as an osteoporotic fracture). This is because a doctor will usually begin treatment for osteoporosis without the use of a bone-density test.

A fracture that is linked to osteoporosis usually occurs after minimal trauma without any other underlying condition.

What types of healthcare professionals treat osteoporosis?

The different types of healthcare specialists who treat osteoporosis include general practitioners, endocrinologists, gynaecologists and rheumatologists. When bone fractures occur, a bone surgeon known as an orthopaedist may treat the fracture if surgery is required.

How long will osteoporosis last?

There is no cure for osteoporosis. It is a chronic condition, this means that it is long-term. Through effective diagnosis and treatment, one may be able to achieve significant improvements in bone mass, thus decreasing the chances of a fracture occurring.

Bone mass will not normally return to its previous healthy, normal state after treatment, however, fracture risk will dramatically decrease.