Osteopenia - Diagnosis

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How is osteopenia diagnosed?

Osteopenia is diagnosed using measures of bone mineral density (BMD). The test recommended by the National Osteoporosis Foundation to measure BMD is the dual energy X-ray absorptiometry scan or DXA scan (formerly known as DEXA scan). A DXA scan measures BMD in the hip, spine, and sometimes the wrist. These locations are chosen because these are frequent sites of bone fracture. The DXA is a very accurate predictor of future fracture risk.

The DXA scan gives two results: a "T score" and a "Z score." The Z score compares the patient's BMD to the average of a person of the same age and sex. The T score compares the BMD to a healthy 30-year-old of the same sex. These scores are measured in standard deviations above or below normal. For example, if a T score is -1.0, this indicates a BMD that is 1.0 standard deviations below a healthy 30-year-old of the same sex. In other words, the lower the bone mineral density, the lower the T score or Z score and the higher the risk of fracture. The risk for fracture doubles with every standard deviation below normal. So, someone with a T score of -2.0 has an approximately twofold increased risk of fracture as compared to someone with a T score of -1.0.

T scores are used to diagnose osteopenia and osteoporosis; those between -1.0 and -2.5 indicate osteopenia, and T scores lower than -2.5 indicate osteoporosis. But it is important to realize that T scores are not the only indication of osteoporosis: if someone has a bone fracture without trauma, then they have osteoporosis by definition, regardless of T score. These patients should be treated as though they have osteoporosis, even if their T score is normal or in the osteopenic range.

Other tests used to measure bone density include the peripheral dual-energy X-ray absorptiometry (pDXA), quantitative computed tomography (QCT), peripheral QCT (pQCT), and quantitative ultrasound densitometry (QUS). Bone density test results can be obtained by any of these methods. Sometimes a routine X-ray reveals diffuse osteopenia (osteopenia in all bones visualized by the X-ray) or osteopenia of a particular location, such as spinal osteopenia. Periarticular osteopenia is an indication of inflammation around a certain joint. This can be seen in conditions such as rheumatoid arthritis and does not necessarily indicate a decreased BMD throughout the bony skeleton. While routine X-rays may suggest decreased bone mineral density, the DXA scan is much more precise in diagnosing osteopenia and osteoporosis.

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See what others are saying

Comment from: pg, 55-64 Male (Patient) Published: August 23

I experienced pain in my ankle on the resumption of walking following a pulmonary rehab program. The area to the side of my ankle was injected on the assumption that the problem was tendonitis. An X-ray was then requested and the doctor said there was no damage to be seen. finally an MRI scan showed a fracture of my ankle. In all five weeks elapsed between the initial pain an diagnosis. A subsequent DEXA scan revealed osteopenia and the explanation for my fracture I am told.

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