Diagnosis Osteoporosis

1 diagnosis

1.1 conventional radiography
1.2 dual-energy x-ray
1.3 biomarkers
1.4 other measuring tools
1.5 screening

diagnosis

multiple osteoporotic wedge fractures demonstrated on lateral thoraco-lumbar spine x-ray

the diagnosis of osteoporosis can made using conventional radiography , measuring bone mineral density (bmd). popular method of measuring bmd dual-energy x-ray absorptiometry.

in addition detection of abnormal bmd, diagnosis of osteoporosis requires investigations potentially modifiable underlying causes; may done blood tests. depending on likelihood of underlying problem, investigations cancer metastasis bone, multiple myeloma, cushing s disease , other above-mentioned causes may performed.

conventional radiography

conventional radiography useful, both , in conjunction ct or mri, detecting complications of osteopenia (reduced bone mass; pre-osteoporosis), such fractures; differential diagnosis of osteopenia; or follow-up examinations in specific clinical settings, such soft tissue calcifications, secondary hyperparathyroidism, or osteomalacia in renal osteodystrophy. however, radiography relatively insensitive detection of disease , requires substantial amount of bone loss (about 30%) apparent on x-ray images.

the main radiographic features of generalized osteoporosis cortical thinning , increased radiolucency. frequent complications of osteoporosis vertebral fractures spinal radiography can considerably in diagnosis , follow-up. vertebral height measurements can objectively made using plain-film x-rays using several methods such height loss area reduction, particularly when looking @ vertical deformity in t4-l4, or determining spinal fracture index takes account number of vertebrae involved. involvement of multiple vertebral bodies leads kyphosis of thoracic spine, leading known dowager s hump.

dual-energy x-ray

dual-energy x-ray absorptiometry (dexa scan) considered gold standard diagnosis of osteoporosis. osteoporosis diagnosed when bone mineral density less or equal 2.5 standard deviations below of young (30–40-year-old), healthy adult women reference population. translated t-score. because bone density decreases age, more people become osteoporotic increasing age. world health organization has established following diagnostic guidelines:

the international society clinical densitometry takes position diagnosis of osteoporosis in men under 50 years of age should not made on basis of densitometric criteria alone. states, premenopausal women, z-scores (comparison age group rather peak bone mass) rather t-scores should used, , diagnosis of osteoporosis in such women should not made on basis of densitometric criteria alone.

biomarkers

chemical biomarkers useful tool in detecting bone degradation. enzyme cathepsin k breaks down type-i collagen protein, important constituent in bones. prepared antibodies can recognize resulting fragment, called neoepitope, way diagnose osteoporosis. increased urinary excretion of c-telopeptides, type-i collagen breakdown product, serves biomarker osteoporosis.

other measuring tools

quantitative computed tomography differs dxa in gives separate estimates of bmd trabecular , cortical bone , reports precise volumetric mineral density in mg/cm rather bmd s relative z score. among qct s advantages: can performed @ axial , peripheral sites, can calculated existing ct scans without separate radiation dose, sensitive change on time, can analyze region of size or shape, excludes irrelevant tissue such fat, muscle, , air, , not require knowledge of patient s subpopulation in order create clinical score (e.g. z-score of females of age). among qct s disadvantages: requires high radiation dose compared dxa, ct scanners large , expensive, , because practice has been less standardized bmd, results more operator-dependent. peripheral qct has been introduced improve upon limitations of dxa , qct.

quantitative ultrasound has many advantages in assessing osteoporosis. modality small, no ionizing radiation involved, measurements can made , easily, , cost of device low compared dxa , qct devices. calcaneus common skeletal site quantitative ultrasound assessment because has high percentage of trabecular bone replaced more cortical bone, providing evidence of metabolic change. also, calcaneus flat , parallel, reducing repositioning errors. method can applied children, neonates, , preterm infants, adults. ultrasound devices can used on tibia.

screening

the u.s. preventive services task force (uspstf) recommend women 65 years of age or older screened bone densitometry. additionally recommend screening women increased risk factors puts them @ risk equivalent 65‑year‑old. there insufficient evidence make recommendations intervals repeated screening , appropriate age stop screening. in men harm versus benefit of screening osteoporosis unknown. prescrire states need test osteoporosis in have not had previous bone fracture unclear. international society clinical densitometry, however, suggest bmd testing men 70 or older, or indicated risk equal of 70‑year‑old. number of tools exist determine reasonable test.