Diagnosis of osteoporosis

Medically Reviewed By : Dr Sravya , MBBS, MS

Introduction

Did you know? Worldwide, osteoporosis causes more than 8.9 million fractures annually, which means every 3 seconds, there is an osteoporosis fracture! It has been referred to as a silent disease, as it does not show any symptoms until a bone fracture occurs.

Osteoporosis develops over the years and is often diagnosed after a sudden bone fracture. It is a health condition that will weaken the bones and make them fragile enough to break.

Tests are done to measure bone density or bone mass to confirm the presence of osteoporosis, or they may also be done in people to detect the presence of osteopenia (decreased bone mass), which is a risk factor for developing osteoporosis. Now let’s dive into the details of osteoporosis, its causes, diagnosis, treatment plans, and preventive measures.

In This Article

What is osteoporosis?

The word Osteoporosis is derived from the Greek words ‘osteon, which means bone, and ‘poros, which means bone Osteoporosis is a condition where the bones become weak and brittle. Our body constantly reabsorbs old bone tissue and replaces it with new bone tissue as a process of bone remodeling. Oubonesnare is made of outer Narbonne, called cortical bones, and inner spongbonesne, called trabeculabonesne. Our bones store calcium and other minerals. When our body needs calcium, the bone tissue is reabsorbed and rebuilt.

Until 30 years of age, the body makes up more bone than the resorbed bone Generally, the re-absorption starts to occur at a faster rate, leading to a loss of bone mass in our body. In the case of osteoporosis, the new bone formation doesn’t keep up with the bone removal, which makes the holes in the spongy bone grow larger and more numerous. This will make the bones brittle and weaker. If you have osteoporosis, you lose more bone mass than normal.

There are different types of osteoporosis. They are:

What are the signs and symptoms of osteoporosis?

There are no or few noticeable symptoms in the case of osteoporosis. The disease can progress without a person even knowing. Often, a person with osteoporosis will not receive a diagnosis until they experience a broken bone.

Loss of height: If you notice getting shorter in height by an inch or more, This is due to a fracture in the spine.
Change in posture - Due to fractures of the vertebrae or spine, stooping or bending forward posture can occur (kyphosis).
Shortness of breath: The lung capacity gets reduced due to compression by the disks.
Bone fractures: sudden or frequent bone fractures, even in a minor incident such as a fall, a cough, or a sneeze
Pain in the lower back: sudden lower back pain can be due to hip fractures in cases of osteoporosis

Who is at risk for osteoporosis?

Research shows that at 50 years of age, 1 in 5 men and 1 in 3 women will experience fractures due to osteoporosis. Women in middle age or postmenopausal age will have a high risk of developing osteoporosis. This is due to the slowdown in the production of estrogen hormones, which prevent excessive bone loss.

Men in middle age are also at risk for osteoporosis-induced bone fractures due to a gradual decrease in testosterone production. There are various factors causing osteoporosis, including age, sex, family history, dietary habits, hormonal imbalances, medication, and health conditions.

1. Uncontrollable factors:

Sex: Women are more likely to get osteoporosis than men.
Age: The older you get, the greater your risk of osteoporosis.
Family history: having a parent or sibling with osteoporosis brings you a greater risk.
Race: If you're white or of Asian descent, the risk is high

2. Unhealthy habits:

Alcohol consumption: Regular consumption of alcohol increases the risk of osteoporosis.
Tobacco: It has been shown that tobacco use contributes to weak bones and may lead to osteoporosis
Lifestyle: People with less active or sedentary lifestyles have a higher risk of developing osteoporosis. Any weight-bearing exercise, such as walking, running, jumping, dancing, and weightlifting, seems helpful.

3. Hormonal imbalances:

Thyroid problems: higher thyroid hormone levels can cause bone loss. This can occur if the thyroid gland is overactive or if you are taking too much thyroid hormone medication to treat an underactive thyroid.
Sex hormones: the fall in estrogen levels in women at menopause is a strong risk factor for developing osteoporosis in women. Reducing testosterone levels in men is likely to accelerate bone loss. Lowering sex hormones increases the rate of bone loss.
Others: Osteoporosis has also been seen to have an association with overactive parathyroid and adrenal glands.

4.Dietary factors:

Low calcium intake reduces bone density, leads to early bone loss, and increases the risk of fractures.
Some eating disorders, like Anorexia nervosa, can cause underweight and lower bone mass, leading to osteoporosis.
Gastrointestinal surgery: surgery to reduce the size of your stomach or to remove part of the intestine to help you lose weight or for other gastrointestinal disorders that limit the absorption of nutrients and minerals

Disease conditions and their medications:

Some medications used to prevent some diseases can lead to osteoporosis. Some diseases include Kidney or liver disease, Cancer, Multiple myeloma, and Inflammatory bowel disease. The long-term use of corticosteroid medications, such as prednisone and cortisone, can interfere with the bone-rebuilding process

Diagnosis of Osteoporosis

Your physician will take a detailed medical history, including past medication history, family history, and disease history. If they suspect osteoporosis, they will advise you to take tests to measure bone density or bone mass. The tests include:

1.Bone mineral density scan (BMD):

This uses an X-ray called dual-energy X-ray absorptiometry (DEXA). This is advised to determine the risk of bone fractures, identify the bone density, confirm the diagnosis, monitor the treatment course, and monitor the patient’s response to it.

Doctors may recommend taking this test if you have:

1. lost at least 1.5 inches, which is 3.8 centimeters in height. They may have compression fractures in their spines, which have happened due to osteoporosis.
2. fracture a bone too easily, even with a strong cough or sneeze.
3. Certain drugs taken long-term, such as steroid medications, interfere with the bone-rebuilding process
4. Had a drop in hormone levels after menopause or in some cancer treatments.

These tests are usually done on the bones, which are more susceptible to fracture due to osteoporosis.

1. 1. Bone density tests are done on bones that are likely to break due to osteoporosis, including:
  2. lumbar vertebrae (lower spine bones)
  3. femur (thigh bone)
  4. Bones on the forearm

How do you Prepare for the Test?

1. Do not consume your calcium supplements for 24 hours before the test.
2. Remove metal items, such as jewelry, from your body.
3. If you are or could be pregnant, then inform your physician.

There are two types of devices to carry out a DEXA scan:

A central DEXA: This is a hospital-based scan. The scanner passes over your lower spine and the hip area to measure hip and spine bone mineral density while the individual lies on a table. In most cases, you do not need to undress for scanning. This scan is the best way to predict your risk for fractures. The amount of radiation you’re exposed to is very low, and test durations will be 10 to 30 minutes.

A peripheral DEXA: This is a mobile machine that tests to measure the bone density in your wrist, fingers, leg, or heel and will help in fracture risk prediction. As bone density will be different from one location to another in our body. This test taken at your heel may not very accurately predict your fracture risk. If you test positive, your healthcare provider might advise a follow-up scan of your spine or hip to confirm your diagnosis.

The results of your DEXA test are reported in two numbers: the T-score and the Z-score.

The T-score is a value of your bone density compared with the peak bone mass of a healthy young adult of your sex. Your T-score is the number of units called standard deviations. This interprets your bone density as being above or below the average.

Your Z-score compares bone mass with someone of your age, sex, weight, and ethnic or racial origin. If your Z-score shows any abnormalities, then you need to take additional tests to determine the cause of this problem.

What does your score mean?

1. If the T score is -1 and above, then Your bone density is considered normal.
2. If T-score is between 1 and -2.5, Your score shows a sign of osteopenia, where the bone density is below normal and may lead to osteoporosis.
3. If your T score is -2.5 and below, then Your bone density indicates you likely have osteoporosis.

2. Ultrasound scan:

An ultrasound scan of the heel bone is another method used by physicians for assessing osteoporosis. It is less common than DEXA.

3. Laboratory assessment

Tests to check the renal function, thyroid function, calcium level, and vitamin D level

4. The Fracture Risk Assessment Tool (FRAX):

It is a questionnaire that helps accurately measure the fracture probability for up to 10 years. has become a more accurate way to measure 10-year fracture probability.

5. Secondary tests:

This is to check for secondary osteoporosis, which tests for 24-hour urine calcium levels, testosterone levels, parathyroid hormone levels, gonadotropin levels, and serum markers of osteoblasts and osteoclasts.

Nursing Diagnosis of Osteoporosis

Nursing care for a medically diagnosed osteoporosis patient includes providing vitamin D and calcium supplementation, verifying whether the patient adheres to proper nutrition and drug therapy, following proper exercise, and preventing falls and fractures.

Some appropriate nursing diagnoses which might be for patients with a medical diagnosis of osteoporosis are the following

Treatment for osteoporosis?

The osteoporosis treatment aims at preventing or slowing the development of osteoporosis, maintaining good bone density and mass, and reducing pain and fractures. Treatment is also done to provide supplements to people who are at risk.

Medication helps to prevent and treat osteoporosis.

Bisphosphonates are antiresorptive drugs that slow bone loss and reduce fracture risk.
Estrogen agonists or antagonists are also called selective estrogen-receptor modulators (SERMS). These can reduce the risk of spine fractures in women during the postmenopausal period.
Example: Raloxifene (Evista)
Calcitonin (Calcimar): This medication prevents spine fractures in women who are in postmenopausal stages.
Parathyroid hormone (such as teriparatide): This stimulates bone formation, and this hormone is used for treating people with a high risk of fracture.
Monoclonal antibodies (denosumab) are taken by some people with osteoporosis after menopause.

Can you prevent osteoporosis?

Osteoporosis risk may be reduced by the following measures, such as:

If you are a person with osteoporosis, you should continue the above measures and the proper medication prescribed, along with preventing falls, to avoid any bone fractures and further complications.