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Osteoporosis is condition in which bones become weaker with age and are more easily broken. There are no symptoms of this disease until fractures occur. It is estimated that the average 50-year-old woman has about a 40% chance of developing an osteoporosis related fracture sometime during her remaining life.
Osteoporosis can be diagnosed in two ways. The clinical diagnosis of severe osteoporosis can be made once a spine or hip fracture occurs because the majority of these fractures are due to osteoporosis. The second method of diagnosis is preferable, and it is done by performing a bone density test well before fractures occur when the bones of the skeleton may still respond to preventative measures.
Bone density measurements are a quick and painless office procedure which allows the physician to determine your likelihood for bone fracture. The gold standard is a DEXA test (Dual Energy X-ray Absorptiometry) which can measure the strength of your spine vertebra or hip. Newer technologies are also available to measure the density of your wrist by p-DEXA (peripheral DEXA) or heel by ultrasound or SXA (Single X-ray Absorptiometry). These newer methods use smaller instruments that many physicians now can use in their office.
If any bone density measurement suggests the presence of osteoporosis, your doctor should begin treatment. This usual course or treatment most often consists of drug therapy.
Sometimes a woman at risk for bone fracture can have a normal density measurement of her wrist or heel and still have osteoporosis of the spine or hip. This is because bone is lost at different rates at different skeletal sites. The ISCD (International Society for Clinical Densitometry) does recommend that all women that have had a normal peripheral measurement (of wrist or heel) should have a central DEXA done if any risk factors are present.
Risk factors for Osteoporosis include a mother who has had a hip fracture, height greater than 5' 7", weight less than 125 pounds, loss of height that exceeds 1.5", smoking, a medical history of hyperthyroidism, hyperparathyroidism, chronic liver disease or gastrointestinal malabsorption, or the use of high risk medications including, thyroid replacement, steroids (Prednisone), any seizure medication and any medication that disrupts normal menstrual cycles.
With proper understanding of the bone density findings physicians are well on their way to identify those patients most likely to respond to therapeutic interventions.
David Podlecki, M.D.,F.A.C.E., is board certified in internal medicine and endocrinology. He joined the staff of Longmont Clinic in March 1982.
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