How to diagnose osteoporosis

Clinical, Radiological and

Biochemical tools
 Clinical features
• Osteoporosis is asymptomatic unless fractures occur.
• Fracture of the distal radius is usually the first fracture
to occur, followed by vertebrae and hip unless
treatment is initiated.
• In severe cases, significant height loss (often exceding
4 cm) and thoracic kyphosis can occur due to multiple
vertebral fractures.
 Radiological tools
• The diagnosis of osteoporosis relies on the
quantitative assessment of bone mineral density
(BMD), which is currently considered the best
predictor of osteoporotic fractures.
• Measurements are usually taken from the lumbar
spine and hip, but they can also be taken from the
distal forearm and total body.
• The gold standard investigation for measurement of
bone mass is the dual-energy x-ray absorptiometry
(DXA) scan.
• Bone mass values from DXA (Dual-energy X-
Ray Absorptiometry) scans are two-
dimensional estimates of bone density
presented as the number of standard deviations
below the young adult mean (T score) and the
number of standar deviations below the age-
matched mean (Z score).
Some experts use Z-score of < -2 to view for secondary
causes of osteoporosis; also can be used in young
patients to assess for peak bone density
 Indications for bone densitometry

• All women over the age of 65

• All women during the menopausal transition with risk
factors for fracture
• All postmenopausal women
• All individuals over the age of 50 who suffer an
osteoporotic fracture
• All individuals who are taking long term corticosteroids
(7.5mg of prednisone daily for 3m)
• All men over the age of 65
• Men with hypogonadism
• Patients with diseases associated with bone loss and
fracture.
 Biochemical test
• Serum calcium and phosphate concentration
should be measured in the fasting state
• Serum alkaline phosphatase
• Parathyroid hormone
• Vitamin D
• Urin calcium and phosphate