Osteoporosis (cont.)
How is osteoporosis diagnosed?
A routine x-ray can reveal
osteoporosis of the bone, which appears much thinner and lighter than normal
bones. Unfortunately, by the time x-rays can detect osteoporosis, at least 30%
of the bone has already been lost. In addition, x-rays are not accurate
indicators of bone density. The appearance of the bone on x-ray is often
affected by variations in the degree of exposure of the x-ray film.
The National Osteoporosis Foundation, the American Medical Association, and other major medical organizations are recommending a dual energy x-ray absorptiometry
scan (DXA, formerly known as DEXA) for diagnosing osteoporosis. DXA measures bone density in
the hip and the spine. The test takes only 5 to 15 minutes to perform, uses very
little radiation (less than one tenth to one hundredth the amount used on a
standard chest x-ray), and is quite precise.
The bone density of the patient is
then compared to the average peak bone density of young adults of same sex and
race. This score is called the "T score," and it expresses the bone density in
terms of the number of standard deviations (SD) below peak young adult bone
mass.
- Osteoporosis is defined as bone density T score of
-2.5 SD or below.
- Osteopenia (between normal and osteoporosis) is defined as bone density T score
between -1 and -2.5 SD.
Who should have bone density testing?
The National Osteoporosis Foundation guidelines state that there are several
groups of people who should consider DXA testing:
- All postmenopausal women below age 65 who have risk factors for
osteoporosis;
- All women aged 65 and older;
- Postmenopausal women with fractures, although this is not mandatory
because treatment may well be started regardless of bone density;
- Women with
medical conditions associated with osteoporosis. These diseases number more than
50. A primary care physician can scan a patient's list of medical illnesses to
verify that one of these conditions is not present;
The National Osteoporosis
Foundation guidelines state that bone density testing does not need to be
performed if a person has a known osteoporotic fracture because the condition
will be treated with or without bone density results. In addition, bone density
testing is not appropriate if the person undergoing the test is not willing to
take any treatment based on the results. Therefore, if bone density testing is
done, it should be performed on people willing to take some specific action
based on the results.
Next: How is osteoporosis treated and prevented? »
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