Diagnosing Methods For Osteoporosis
Osteoporosis is the most common metabolic bone disease there is. Osteoporosis fractures produce significant health issues and the health system receives an enormous economic burden from them. Bone mineral density (BMD) testing remains the cornerstone for osteoporosis evaluation. BMD has an excellent correlation with fracture risks and permits medical providers to not only decide if medication is appropriate but also decide how well the individual is responding to the treatment.
Initial ways of figuring out bone mineral density (BMD) relied on conventional radiographs and looked at trabecular bone patterns with attempts at grading. This turned out not to be accurate. This was back in the 1950’s and by the next decade, single photon absorptiometry was developed. Eventually this turned into dual photon absorptiometry, which was really good at telling bone apart from soft tissues.
The standard of care that has been developed for BMD is dual energy x-ray absorptiometry (DXA). This technology differentiates between bone from soft tissue by evaluating photon beams that are transmitted through two different energy levels. As the beams travel through the various tissues, they become weakened differently.
A DEXA scan measures bone mineral density in addition to area. The bone mineral density is divided by the area, and then it is made into a T score. Serial testing of the bone mineral density allows one to determine the changes over time.
Bone mineral densities are defined by the World Health Organization according to a T score. A young normal has been defined into a normal T score, which in order to be normal a person’s BMD would be within one standard deviation. If a person’s T score is between 1 and 2.5 standard deviations, then the definition is osteopenia. Osteoporosis is if the BMD is above 2.5 standard deviations.
For treatment of those with a T score under 2.0, the National Osteoporosis Foundation recommends medication. Major risk factors have also been published in their treatment guidelines: Family history of fracture, personal history of fracture, weight under 127 pounds, and current cigarette smoker.
They have also recommended the various groups that should be tested with DXA. They include: All women over age 65, Postmenopausal women with major risk factors, All people over age 50 who suffer an osteoporotic fracture and anyone taking long term corticosteroids. With regards to men, anyone over age 70 or experiencing a hypogonadal condition should be tested.
Depending on the T scores resulting from the repetitive DXA scans, treatment decisions can be adjusted consisting of anti-resorptive agents along with weight bearing exercise.
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