Osteoporosis is different from most other diseases or illnesses because there is not a single cause. Different testing methods may help determine if you have or are at risk for osteoporosis. If osteoporosis is suspected, a diagnosis must be made before an appropriate treatment plan can be developed. Early treatment is essential to preventing osteoporosis-related fractures, like compression fractures.
Your doctor will usually order skeletal X-rays and specialized laboratory tests as well as a measurement of your bone mass.
In order to rule out other possible conditions, the first step is to take a complete medical history, including a review of your symptoms and current medications (both over the counter and prescription). Osteoporosis may run in families, so it may have a genetic cause. Your doctor will likely want to know if anyone else in your family has the condition. Your doctor may ask the following questions:
- Have you broken bones?
- Have you gotten shorter?
- How is your diet, especially dairy intake? Do you think you get enough calcium? Vitamin D?
- How often do you exercise? What type of exercise do you do?
- How is your balance?
- Do you have a family history of broken bones or osteoporosis?
- Have you taken corticosteroid medications as pills, injections or creams?
- What are your periods like?
- Have you reached menopause?
Tip: It may be useful to prepare these answers ahead of time or keep a log of your symptoms, so your doctor can get a better sense of how your condition has developed over time. You can track your symptoms on DoctorPlan, giving your doctor access to a full understanding of your experience.
A comprehensive physical exam will also be conducted for your doctor to get a better understanding of your condition.
A typical physical examination may include all or some of the following elements:
- Assessment of your height, weight and vital. Your doctor will measure your height and compare this to previous measurements. This step is always important for your doctor to record anything about your general health, before looking at your specific condition.
- Inspection of your skin.
- Examination of your breathing and your abdomen.
- Your doctor may ask you to walk or move your body into different positions to obtain a sense of how well your spine moves and whether any specific movements cause pain.
- Examination of the contour of your spine.
- Range of motion assessment.
- Your doctor may apply light pressure to your spine to locate and document areas of tenderness or spasms and to assess for any masses or swelling. If the vertebra fracture is recent, your doctor will often localize tenderness and observe noticeable bruising or swelling over that area.
- During the neurological part of the examination your doctor will test your reflexes, sensation, and motor strength. Sensation is assessed by gently touching a pin to skin and is usually tested in both your arms and your legs.
Following a comprehensive medical assessment, your doctor may recommend that you have your bone mass measured. A bone mineral density (BMD) test is an important measure of your bone health. This test helps determine the severity of the bone thinning. BMD tests can identify osteoporosis, determine your risk for fractures and measure your response to osteoporosis treatment.
Several different types of BMD tests are used today. The most widely recognized BMD test is a central dual-energy X-ray absorptiometry, or central DXA test. It is a bit like having an X-ray done, but with much less exposure to radiation. It can measure bone density in your hip and spine. BMD tests can:
- Detect low bone density before a fracture occurs
- Confirm a diagnosis of osteoporosis if you already have one or more fractures
- Predict your chances of fracturing in the future
- Determine your rate of bone loss and monitor the effects of treatment if the test is conducted at intervals of a year or more
The BMD test is often performed in women at the time of menopause or to screen for osteoporosis.
A bone density scan provides what is known as a T score, which is compared with the average bone density in a young, healthy male or female adult of the same race or ethnicity. Not everyone gets a T-score, so you may get a Z-score. Women who haven’t gone through menopause and men younger than 70 will still undergo bone densitometry using DXA, but they will get a Z-score. Instead of comparing your bone mineral density to a 20-something adult, your doctor will compare it to the normal BMD for someone your age, gender, body type and race.
Based on the score, your doctor can determine whether you have low bone mass or osteoporosis. Your doctor will consider the score along with your risk factors to determine whether you require osteoporosis treatment.
Additional Diagnostic Techniques
In addition to a DXA and a bone density scan your doctor may use other techniques to identify osteoporosis. These may include:
- single photon absorptiometry (SPA)
- quantitative computed tomography (QCT)
- radiographic absorptiometry, and ultrasound
Your doctor can determine which method is best for you.
Depending on your risk factors, your doctor can help you determine how often you should have a bone density test. Most doctors suggest that all postmenopausal women older than age 50 and men older than 70 have a bone density test once every two years to screen for low bone mass and osteoporosis. However, if you have any of the risk factors listed above or have already been diagnosed with low bone mass, your doctor may suggest earlier and more frequent screening.
If your doctor suspects that vertebral compression fracture caused by osteoporosis, they may order imaging test like X-rays, MRI or CT scans to get a more detailed picture of the spinal column and the soft tissues around it. A Kyphoplasty may be necessary to treat painful compression fractures.
In addition, laboratory tests may be ordered to look at your basic metabolic panel, chemistry, and CBC (complete blood count), levels of vitamin D and hormone tests. If your doctor suspects that other medical conditions, such as parathyroid and thyroid malfunctioning, are causing your bone problems, they may order blood and urine tests to rule this out. These tests may cover calcium levels, thyroid function, and testosterone levels in men.
Disclaimer – All information is for educational pursuit and information purposes only. It is not intended nor implied to be a substitute for personal medical advice. The viewer should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding their medical condition, diagnosis, procedures, treatment plan, or other health related topics.