Diagnosis of Osteoporosis

In 1994, the WHO defined osteoporosis as a "disease characterized by low bone mass and micro-architectural deterioration of bone tissue, enhanced bone fragility and an increase in fracture risk".

Non-invasive methods, such as bone densitometry, provide a measure of the bone mineral density (BMD) expressed as grams of mineral per unit projected area of the bone.

The WHO has standardized the interpretation of BMD results, based on a comparison of a patients BMD with the mean for a normal young adult population of the same sex and race. This apply for white women over the age of 50y.

The patients BMD is calculated as a T-score, which is the number of standard deviations above or below the mean BMD for normal young adults as follows: Normal BMD: T-score no more than -1 SD below the young adult mean Osteopenia: T-score between -1.0 and -2.5 Osteoporosis: T-score equal to or less than -2.5 Severe osteoporosis: T-score below -2.5 for patients with a fragility fracture

However, the WHO criteria were derived from European and North American postmenopausal women and may not be applicable to other races.

BMD is a predictor of fracture but bone size,

shape and microarchitectural features of bone are not captured by the measurement. Thus, although the measurement does identify a high-risk group (specific) it is not sensitive; about 50% of persons who will sustain fractures come from individuals with osteopenia (BMD value between 2.5 SD and -1 SD).

Questions

How to diagnose? DEXA, C-T, U/S, bone markers..etc Which DEXA machine? Which site: Radius, Spine or Hip? If there is no DEXA, can we diagnose and treat Osteoporosis? When to start screening for osteoporosis? DEXA is based on non-Egyptians, how can we interpret the results? When to use T-score and Z-score? 50% of fractures are in the osteopenic range, does this mean that diagnosis threshold is different from treatment threshold? The use of fracture risk calculators? Based also on non-Egyptians How to diagnosis in younger age groups?