Clinical presentation and diagnosis Diagnosis

Osteoporosis has been defined by the WHO as a disease characterized by low bone density and weakening of bone tissue associated with an increase in fragility and vulnerability to fracture.1 Because bone strength cannot be measured directly, an assessment of bone mineral density is used, which represents 70% of bone strength. Low bone mineral density has been associated with an increased risk of fractures. X-rays are useful only in identifying patients suspected of sustaining a fracture and are not recommended for diagnosis of osteoporosis.

Measurement of Bone Mineral Density

Bone mineral density can be measured at various sites throughout the skeletal system and by various methods. The site of measurement can be either central (hip and/ or spine) or peripheral (heel, forearm, or hand). Dual-energy x-ray absorptiometry (DXA) can be used to measure central and peripheral sites of bone mineral density.

Quantitative ultrasound, peripheral quantitative computed tomography, radiographic absorptiometry, and single-energy x-ray absorptiometry are used to measure peripheral sites.

'©' The WHO recommends a standardized approach to measuring bone mineral density for diagnosis of osteoporosis using central measurement of bone mineral density by DXA 9 Central DXA is recommended for diagnosis due to inconsistencies in T-scores measured between different sites and by different methods.1,2 Current standards of practice consist of measuring bone mineral density at the lumbar spine and hip, although the WHO suggests the hip is the preferred site for diagnosis.8,1

Peripheral bone mineral density measurements cannot be used for diagnosis because they do not correlate with central measurements. However, they are useful in identifying patients who are candidates for central DXA and who are at increased risk of fracture. They may also be useful in patients who have had multiple fractures or in low-risk patients. Additionally, peripheral measurement of bone mineral density is generally less expensive than central DXA and is easily accessible. Instruments used for peripheral bone densitometry are portable, which allows bone density to be measured in pharmacies and health-fair screening booths.

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