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Osteoporosis

Diagnosis
International Osteoporosis Foundation
The content of this section is provided by the International Osteoporosis Foundation.
More information is available at: www.iofbonehealth.org
© Copyright 1999-2007 International Osteoporosis Foundation

The importance of early diagnosis

Men and women over 60 are at higher risk of osteoporosis than younger people. Nevertheless, it is possible to have osteopenia (low bone mass) or osteoporosis at a much earlier age. As osteoporosis has no obvious symptoms other than a fracture when the bone is already significantly weakened, it is important to go to your doctor if any of the risk factors apply to you (see risk factors). By making positive lifestyle changes and following appropriate treatment strategies in consultation with a doctor (see treatment), osteoporotic fractures can be prevented. Your doctor will take a thorough medical history that includes information on any recent fractures and may determine that the next step is to have a bone mineral density (BMD) test.

BMD test options

Traditional X-rays can¿t measure bone density, but they can identify spine fractures. Bone mineral density (BMD) has to be measured by more specialised techniques. A number of different types of BMD tests are available, but the most commonly used is DXA (dual-energy X-ray absorptiometry).
  • DXA is a low radiation X-ray capable of detecting quite small percentages of bone loss. It is used to measure spine and hip bone density, and can also measure bone density of the whole skeleton.
  • pDXA (peripheral DXA) measures bone mass at the forearm, finger and heel
  • SXA (single-energy X-ray absorptiometry) measures the heel or wrist
  • DPA (dual photon absorptiometry) measures the spine, hip or total body
  • SPA (sinlge photon absorptiometry) measures the wrist
  • QCT (Quantitative Computed Tomography) measures the spine or hip. pQCT (peripheral QCT) measures the forearm.
  • QUS (Quantitative Ultrasound) uses sound waves to measure density at the heel or finger.
DXA scan is used to measure spine and hip bone density, and is the most common technique for assessing the risk of osteoporosis.
The World Health Organization has defined a number of threshold values for osteoporosis. The reference measurement is derived from bone density measurements in a population of healthy young adults. Osteoporosis is diagnosed when a person¿s BMD is more than 2.5 times below this reference measurement. Osteopenia is diagnosed when the measurement is between 1 and 2.5 times below the young adult reference measurement.
StatusHip BMD
NormalT-score of -1 or above
OsteopeniaT-score lower than -1 and greater than -2.5
OsteoporosisT-score of -2.5 or lower
Severe osteoporosisT-score of -2.5 or lower, and presence of at least one fragility fracture
If the results of your BMD test show osteopenia or osteoporosis, it does not automatically mean that you will have a fracture. There are lifestyle changes and a number of available therapies that your doctor might prescribe to slow down bone loss and help prevent fractures (see treatment).
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