The usual signs of osteoporosis are repeated fractures, often due to minor accidents. Diagnosing osteoporosis is done with a bone mineral density DEXA scan.
Osteoporosis occurs when minerals are lost from the bones. This reduction in bone mineral density (BMD) weakens the bones and makes them more susceptible to fracture. The condition is most common in post-menopausal women, 40% of whom are likely to suffer an osteoporotic bone fracture at some time after the age of 50 years.
Signs of Osteoporosis
Osteoporotic fractures can occur following a relatively minor fall or other accident. Any bone can be affected, but breakages are most common in the vertebrae of the spine, the forearm and wrist, and the hip. A particular type of wrist fracture known as a Colles fracture is common in people with osteoporosis.
Osteoporosis does not cause pain in itself; however, back pain can become a problem for people who have suffered a fractured vertebra, especially if osteoarthritis develops at the site of the injury. Repeated vertebral fractures can cause deformities of the spine (formerly called a dowagers hump or hunchback), while compression of osteoporotic vertebrae may lead to loss of height.
Diagnosing Osteoporosis – Bone Mineral Density and DEXA
Osteoporosis is generally diagnosed only after an osteoporotic fracture has already occurred. The diagnosis is usually considered when a patient in a high-risk group (e.g. a post-menopausal woman) sees her doctor with a fracture at one of the typical sites.
The doctor may request blood tests to check the levels of substances involved in bone remodelling, and an X-ray to look for evidence of other fractures. A definite diagnosis of osteoporosis needs a measure of BMD, however, and this is provided by an examination called dual-energy X-ray absorptiometry (DEXA or DXA).
In DEXA, the patient is exposed to two doses of X-rays of different energies. The amount of energy absorbed as the X-rays pass through the body differs between the two doses and between soft tissues and bone, and this information is analysed by a computer to calculate the BMD of the bones of interest. This is expressed as a value called a T score, with cut-off points for normal bone, osteoporosis and osteopenia (a BMD intermediate between normal and osteoporosis).
DEXA is widely employed to measure BMD in adults, being inexpensive, easy to use and tested in many studies. Patients are exposed to radiation during the scan, but the dose is low (less than the amount of radiation people receive every day from natural sources). Overall, DEXA is considered a safe technique and the best way to diagnose osteoporosis and monitor its treatment.
Osteoporosis Screening
Although osteoporosis is usually diagnosed after a fracture has occurred, DEXA can be used to screen people in high-risk groups who do not yet show any signs of the condition. In the UK, routine screening of post-menopausal women is currently not recommended, though the situation is under review. The US Preventive Services Task Force suggests that all women over the age of 65 years (or over 60 years if they have risk factors for osteoporosis) should have a DEXA test, though how often the scan should be repeated is unclear.
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