Osteoporosis Diagnosis
Bone Density Testing And DEXA Scans

How to diagnose OsteoporosisPictures of Osteoporosis

Testing for Osteoporosis

Osteoporosis Diagnosis

Contents

Who Should Be Tested For Osteoporosis?
Choosing A Specialist
How Is It Tested?
What Is a T-Score?
How Often Should I Be Tested?
What New Methods Are There For Testing?
What About The Costs?


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Guide To Osteoporosis

Who Should Be Tested For Osteoporosis?

There are two groups of women who should generally consult a doctor about testing for osteoporosis. The first group is women aged 50s and upwards who are have osteoporosis risk factors and would like to know the health of their bones. The second group is those women who have already experienced symptoms of osteoporosis (such as a fracture or height reduction). Another important category is women who have had a history of missed periods (amenorrhea) or irregular periods (oligomenorrhea).

What The Experts Say

The combined recommendations of the National Osteoporosis Foundation and the International Society of Densitometry recommend the following people need a bone density test:

1. All women aged 65 and over and all men 70 and over.
2. Postmenopause women under the age of 65 with risk factors such as:
- A family history of osteoporosis.
- Low body weight (less than 126 pounds/9 stone/57kg, regardless of height).
- Smokers.
- History of low-trauma fractures, including hip, wrist and spinal fractures after the age of 45.
3. Adults with a disease associated with bone mass loss such as rheumatoid arthritis, hyperthyroidism, chronic kidney disease, cirrhosis of the liver, hypercalciuria, osteogenesis imperfecta (OI, a condition causing extremely fragile bones), overactive parathyroid gland and Ehler-Danlos syndrome.
4
. Adults taking medications associated with reducing bone mass such as prednisone, thyroid medications like L-Thyroxine, heparin, a blood thinner and medications to treat seizures.
5
. All patients who have been discovered to have reduced bone density when tested for another condition by X-ray.

Choosing A Specialist

Family Doctor: Most patients begin their consultation with a visit to the family physician. However most studies show that an osteoporosis diagnosis is more likely to be given by a specialist. If your doctor does not want to recommend a specialist, ask why. Unless you are happy that they are well informed and up to date about bone disorders, insist on a referral. This is important because statistics show that many primary care health providers fail to even discuss about, let alone diagnosis osteoporosis in women over 65. There are many different specialists who can treat osteoporosis, and your doctor will be able to point you to the right one. Possible options include:

Rheumatologists: Specialists who can diagnose and treat diseases of the bones, muscles and joints.

Endocrinologists: Treat diseases of the endocrine system, that is the glands and hormones. They typically treat diseases such as thyroid problems and diabetes, but they may be interested in osteoporosis as many endocrine diseases can cause it.

Gynecologists: As the vast majority of patients with osteoporosis are female, many gynecologists also treat the disease.

Geriatricians: These are specialists who treat disorders in people over 65.

How Is It Tested?

DEXA Scan

The fastest and safest method for testing for osteoporosis is by dual energy x-ray absorptiometry (DEXA) (image). It is also goes by the abbreviations DeXA and DXA. This machine, considered the gold standard for testing for osteoporosis, measures the total bone content of the hips, spine and forearm and only takes a few minutes. The overall accuracy of testing bone mineral density is about 85 to 99 percent. No advance preparation is required for the test, no medications, injections or fasting. The patient should however avoid taking a calcium supplement for 48 hours before testing as they can artificially temporarily increase bone density. Normally you can keep your clothes on, just ensure you are not wearing any metal (like pants zippers, buttons, jewelry) as this can dramatically alter results. A DEXA scan does subject the patient to some radiation, but this is minimal, even less than experienced by a standard chest X-ray.

CT Scan

A CT (computerized tomography) scan is considered one of the best ways of measuring bone density, particularly of the lower spine as it measures trabecular bone which is lost more rapidly after menopause. However CT scans expose the patient to more radiation than a DEXA scan and they are more expensive and take more time.

Ultrasound Scan

Taking an ultrasound scan of the heel is another common way for evaluating the presence of osteoporosis and other bone and joint disorders. It is simple and cheap, but probably not as accurate as a DEXA scan.

Blood and Urine Tests

Researchers are developing new tests using blood and urine samples to measure bone formation and resorption (an important indicator of osteoporosis). Clinicians refer to these tests as 'biochemical markers of bone turnover'. However these markers are more likely to be used for measuring the success of osteoporosis treatment or progression, rather than diagnosis.

What Is A T-Score?

This is the measurement which a DEXA scan provides. The T-score compares the patients bone mineral density to the average score of a young adult (aged 25 to 35) of the same gender and race. The difference between the two measurements is called a standard deviation (or SD for short). So your score can be either minus or plus, if it is zero then you have exactly the same density of the average young woman (very good news!).

The World Health Organization using the following criteria to define osteoporosis based on bone density t-scores:

Normal T-Score: Zero or -1
Low Bone Mass (osteopenia) T-Score: -1 to -2.5
Osteoporosis T-Score: -2.5 or less
Severe Osteoporosis T-Score: -2.5 or less and the presence of one or more bone fractures

Any score below minus one is an indicator of loss of bone mass. If osteoporosis is suspected, a doctor will want to ensure that it is related to aging, rather than any other underlying cause such as degenerative arthritis or disc disease. He will conduct an extensive physical exam, take a complete medical history and may run various blood and urine tests.

Tip: Alternative Treatment for Osteoporosis
Alternative and homeopathic treatment for osteoporosis symptoms.

How Often Should I Be Tested For Osteoporosis?

If you fall into a risk category, your doctor may recommend an annual DEXA test. If you have been diagnosed with osteoporosis you may initially have more tests to check the success of treatment. Outside of this, a test every 2 years is recommended. IMPORTANT NOTE: Different manufacturers of DEXA machines have different readings of bone density. So for this reason, it is important to return to the same radiological unit where possible. If they order new equipment, they will normally try to do so from the same manufacturer.

What New Approaches Are There For Testing?

One new approach is testing a scientific formula or algorithm called FRAX which is based on clinical risk factors. It was validated by the World Health Organization on 60,000 men and women. Risk factors applied include age, gender, bone mineral density, previous fractures, body mass index, smoking and alcohol intake. All the patients’ statistics are put into a program which then produces a score. This score is an estimate of the individual's likelihood of experiencing a fracture over the next 10 years. If the risk is high, then the person can take action before it occurs. For more on prevention, see our osteoporosis prevention article.

How Much Does Testing Cost?

Currently a DEXA scan costs around $250. Most insurance companies will cover the costs if you fall into a risk category but do check your policy for details. Since 1998 Medicare reimburses the cost of bone density tests for people who are estrogen deficient and considered a risk by their doctor, as well as those taking medication for osteoporosis. They will cover the initial scan and a repeat scan 12 months later if the condition was diagnosed, otherwise they will cover the repeat scan after 24 months.

Interesting Facts: See Osteoporosis Statistics

  Related Articles on Osteoporosis Diagnosis

For more on musculoskeletal problems, see the following:

Guide to Arthritis: Symptoms, treatment and alternative therapies.
Losing height with age: What is normal?
Hip Fracture : Signs, diagnosis and treatment.

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