Osteoporosis Diagnosis and Risk Factors

Osteoporosis develops gradually, usually without causing symptoms. A broken bone or fracture, which occurs with minor trauma, such as a fall, is typically the first sign. A diagnosis will be made based on your medical history, physical examination and non-invasive tests to measure the strength and health of your bones (bone density tests). Some people have evidence of multiple spinal compression fractures with height loss and Dowager's hump as their first symptom. Often the spine fracture can occur without significant pain, for unclear reasons. Years later, however, compression fractures can cause chronic pain, especially if they occur in certain parts of the spine or are multiple in number.

At the time of menopause, all women should talk to their health care professionals about osteoporosis and identify their risk for developing it. Some of the common risk factors are:

  • having a small, thin frame
  • personal and/or family history of broken bones in adulthood
  • diet low in calcium
  • excessive thinness
  • smoking
  • excessive alcohol consumption ("moderate drinking" 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)
  • an inactive lifestyle
  • anorexia nervosa
  • absence of menstrual periods or very irregular menses during youth
  • long-term use of such medications as corticosteroids for asthma and arthritis (longer than three to six months)
  • although the disease typically strikes Caucasian and Asian women, African Americans and Hispanic Americans are also at significant risk
  • certain chronic medical conditions including hyperthyroidism, some hyperparathyroidism, some bowel diseases and rheumatoid arthritis
  • certain chemotherapeutic agents have recently been implicated in accelerated bone density loss in breast cancer patients
  • Research sponsored by the National Institute of Mental Health (NIMH) suggests that depression may also be a major risk factor for osteoporosis. A phase IV clinical trial is currently underway that will 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 premenopausal women with major depression and osteoporosis.

Osteoporosis Tests

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. These tests include:

  • complete blood cell count
  • serum chemistry studies

If medical history or physical findings suggest secondary causes (causes other than menopause and age) of bone loss, then additional laboratory tests may be given.

A bone mineral density test (BMD) is the only way to detect low bone mass. This screening test:

  • measures bone strength
  • predicts if your bones are at risk for fracture
  • may monitor the effects of treatment if the test is conducted at intervals of a year or more
  • predicts your future risk for osteoporosis
  • is painless and noninvasive

Simple and painless measurements are usually taken of the bones in your hip, wrist and spine — the most common sites of fractures due to osteoporosis. Some other tests measure bone density in the middle finger, heel, shinbone or total body. A very small amount of radiation may be used, and you typically remain clothed during the procedure. No dyes are injected.

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.

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. It's smart to have your test performed at a facility, such as a hospital or special osteoporosis center, that does bone density testing on a regular basis. Talk with your health care professional about the best test for you:

  • DXA (Dual Energy X-ray Absorptiometry) measures bone density at the spine, hip or total body
  • SXA (Single Energy X-ray Absorptiometry) measures the wrist or heel
  • pDXA (Peripheral Dual Energy X-ray Absorptiometry) measures the wrist, heel or finger
  • RA (Radiographic Absorptiometry) measures the hand and wrist
  • QCT (Quantitative Computed Tomography) measures the wrist or spine
  • Ultrasound uses sound waves to measure the heel, shin bone and kneecap

Osteoporosis Prevention and Management

In scoring your BMD test, your bone density is compared to two standards: "age matched" and "young normal." The age-matched reading (Z-score) compares your bone density to the "norm" for your age, sex and size. The young normal reading (T-score) compares your density to the average bone density of a healthy young adult woman.

Your reading will help your health care professional identify where you score within ranges of normal and to determine whether you are at risk for fracture. Generally, the lower your bone density, the higher your risk for fracture. However, your BMD score will be taken into account 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 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.

According to the American Association of Clinical Endocrinologists' 2001 Medical Guidelines for Clinical Practice for the Prevention and Management of Postmenopausal Osteoporosis, the BMD test is recommended:

  • for risk assessment in perimenopausal or postmenopausal women who have risk factors for fractures and are willing to consider available interventions. "Perimenopause" is a term applied to the several years preceding menopause.
  • in women who have x-ray findings that suggest osteoporosis
  • in women beginning or receiving long-term glucocorticoid therapy or other drugs associated with bone loss
  • in all adult women with symptomatic hyperparathyroidism or other diseases or nutritional conditions associated with bone loss in whom evidence of bone loss would result in adjustment of management
  • for establishing skeletal stability and monitoring therapeutic response in women receiving treatment for osteoporosis
  • in all women 40 years old or older who have sustained a fracture
  • in all women beyond 65 years of age

Medicare and many commercial insurers pay for BMD testing for individuals at risk or already suffering from osteoporosis.

Copyright 2003 National Women's Health Resource Center Inc. (NWHRC).