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All about osteoporosis maintaining bone health types of osteoporosis causes of osteoporosis osteoporosis risk factors risk factors for primary osteoporosis risk factors for secondary osteoporosis consequences of osteoporosis symptoms of osteoporosis diagnosis of osteoporosis osteoporosis treatments osteoporosis medications treatment for osteoporosis in men treatment for osteoporosis in women osteoporosis lifestyle therapy osteoporosis exercises osteoporosis diet prevention of osteoporosis osteoporosis and calcium osteoporosis and magnesium osteoporosis and vitamin D

How is osteoporosis diagnosed?

The diagnosis of osteoporosis is usually made by your doctor using a combination of a complete medical history and physical examination, skeletal X-rays, bone densitometry and specialized laboratory tests. If your doctor finds low bone mass, he or she may want to perform additional tests to rule out the possibility of other diseases that can cause bone loss, including osteomalacia (a vitamin D deficiency) or hyperparathyroidism (overactivity of the parathyroid glands). Bone

densitometry is a safe, painless X-ray technique that compares your bone density to the peak bone density that someone of your same sex and ethnicity should have reached at about age 20 to 25, when it is at it's highest.

Osteoporosis is diagnosed when bone density has decreased to the point where fractures will happen with mild stress, the so-called fracture threshold. This is determined by measuring bone density and comparing the results with the norm. A number of rapid screening techniques are available to measure density at the wrist or the heel; however, the most useful test is the dual-energy x-ray absorptiometry (DEXA), which measures bone density at the sites at which major fractures are likely to occur: the spine and hip. This test is painless and can be performed in about 5 to 15 minutes. It is useful for people at high risk of developing osteoporosis and for those in whom the diagnosis is uncertain. It is also useful for monitoring the response to treatment. Measurements of BMD are given as mg/cm2, which is the average concentration of bone mineral in the areas that are scanned with the imaging tests. In general, normal bone is greater than 833 mg/cm2. Low bone density (osteopenia) is between 833 and 648 mg/cm2. Osteoporosis is lower than 648 mg/cm2. However, physicians often take additional factors into the calculation when predicting more precisely the risk for fracture.

Blood tests may be performed to measure calcium and phosphorus. Further testing may be needed to rule out treatable conditions that might lead to osteoporosis. If such a condition is found, the diagnosis is secondary osteoporosis. High levels of the chemicals deoxypyridonoline and C-telopeptide in the blood may indicate increased risk for hip fracture. These substances are produced when bone is broken down. A urine test detecting a substance called N-telopeptide may indicate bone loss (although it is not associated with any risk for fracture).

It is often performed in women at the time of menopause. Several types of bone densitometry are used today to detect bone loss in different areas of the body. Dual beam X-ray absorptiometry (DXA) is one of the most accurate methods, but other techniques can also identify osteoporosis, including single photon absorptiometry (SPA), quantitative computed tomography (QCT), radiographic absorptometry and ultrasound. Your doctor can determine which method would be best suited for you. Single and dual photon absorptiometry, dual x-ray absorptiometry (DXA), and quantitative CT measure bone density of the lumbar spine, hip, and distal radius or ulna and are useful in diagnosis and in following treatment response. The WHO defines osteoporosis by the DXA results: > 1 standard deviation from the average value in 35-yr-old sex- and race-matched control subjects is defined as osteopenia and suggests osteoporosis; > 2.5 is diagnostic. DXA studies usually are performed at the spine. DXA study of the hip is generally better than that of the spine because it is thought to give some information about cortical and trabecular bone, but study of the spine is easier to perform and probably faster.

On x-ray, vertebrae and other bones show decreased radiodensity from loss of trabecular structure. However, subjective impressions of bone density may be misleading because osteoporosis cannot be diagnosed on x-ray (as radiolucency) until > 30% of bone has been lost. A loss of horizontally oriented trabeculae increases the prominence of the cortical end plates and of the remaining vertically oriented, weight-bearing trabeculae. Anterior wedging in the thoracic region and ballooning of the vertebral interspaces in the lumbar region are characteristic of vertebral fractures. Although the cortices of long bones may be thin because of excessive endosteal resorption, the periosteal surface remains smooth (in contrast to the irregular cortical outline caused by subperiosteal resorption in hyperparathyroidism). Glucocorticosteroid-induced osteoporosis is likely to produce radiolucency of the skull, rib fractures, and exuberant callus formation at sites of healing fractures.

More information on osteoporosis

What is osteoporosis? - Osteoporosis is a thinning and weakening of the bones, usually associated with the aging process. Osteoporosis is a disease, often with no detectable symptoms.
Building and maintaining skeletal health - Factors involved in building and maintaining skeletal health are adequate nutrition and body weight, exposure to sex hormones at puberty, and physical activity.
What types of osteoporosis are there? - Osteoporosis can be classified in various ways based on diagnostic categories, etiology. Osteoporosis can be classified as either primary osteoporosis or secondary osteoporosis.
What causes osteoporosis? - Osteoporosis is related to the loss of bone mass that occurs as part of the natural process of aging. Osteoporosis results when there is excess bone loss without adequate replacement.
What are the risk factors for osteoporosis? - Many disorders are associated with increased risk of osteoporosis. Osteoporosis is far more prevalent in women after menopause due to the loss of the hormone estrogen.
What're the risk factors for primary osteoporosis? - Risk factors for primary osteoporosis include age, gender, race, figure type, lifestyle, diet, and lack of sunlight.
What're the risk factors for secondary osteoporosis? - Risk factors for secondary osteoporosis include genetic disorders, hypogonadal states, endocrine disorders,hematologic disorders, nutritional deficiencies, drugs.
What are the consequences of osteoporosis? - Consequences due to osteoporosis are increased risk of fracture with minor trauma, frequency of traumatic events from lifting and bending impact.
What are the symptoms of osteoporosis? - Patients with uncomplicated osteoporosis may be asymptomatic or may have pain in the bones or muscles, particularly of the back. Osteoporosis becomes apparent in dramatic fashion.
How is osteoporosis diagnosed? - The diagnosis of osteoporosis is usually made by your doctor using a combination of a complete medical history and physical examination.
What're the treatments for osteoporosis? - Treatment for osteoporosis includes eating a diet rich in calcium and vitamin D, getting regular exercise, and taking medication to reduce bone loss and increase bone thickness.
What osteoporosis medications (drugs) are available? - Medications (drugs) to cure osteoporosis include bisphosphanates (Fosamax), calcitonin (Miacalcin), raloxifene, estrogen, and selective estrogen receptor modulators (SERMs).
How to treat osteoporosis in men? - Alendronate and teriparatide have been approved to treat osteoporosis in men. Calcitonin may work in men, treatment with testosterone appears to increase bone density.
How to treat osteoporosis in women? - The non-hormonal bisphosphonate drugs, alendronate and risedronate prevent and treat postmenopausal osteoporosis. Raloxifene is approved for preventing and treating osteoporosis.
What lifestyle changes can help osteoporosis? - Alcohol consumption should also be kept within safe limits. Supplements of calcium plus vitamin D may help maintain bone density. Limiting sodium and avoiding junk food.
What osteoporosis exercises are suggested? - Exercise is very important for slowing the progression of osteoporosis. Taking regular exercise is the single most important action improve the strength of their bones.
What osteoporosis diet is suggested? - A good calcium intake is essential throughout life for healthy bones. Vitamin D helps the absorption of calcium from the intestines. Reducing salt may be useful for osteoporosis patients.
What can be done to prevent osteoporosis? - For prevention and treatment of osteoporosis, patients should be encouraged to stop smoking, limit alcohol consumption and perform weight-bearing exercise.
Osteoporosis and calcium - Calcium could alter the physical-chemical properties of the bone mineral. The daily recommended dietary calcium intake varies by age, sex, and menopausal status.
Osteoporosis and magnesium - Magnesium supplementation is as important as calcium supplementation in the treatment and prevention of osteoporosis.
Osteoporosis and vitamin D - Vitamin D is necessary for the absorption of calcium in the stomach and gastrointestinal tract and is the essential companion to calcium in maintaining strong bones to prevent osteoporosis.
Bone, joint, & muscle disorders

Topics in bone, joint, and muscle disorders

Bone diseases
Bone tumors
Bone cancer
Muscle diseases
Spine (neck and back) disorders
Dupuytren's contracture
Plantar fasciitis
Rheumatoid arthritis
Juvenile rheumatoid arthritis
Septic arthritis (infectious Arthritis)
Psoriatic arthritis
Reiter's syndrome (reactive arthritis)
Ankylosing spondylitis
Gout (gouty arthritis)

All information is intended for reference only. Please consult your physician for accurate medical advices and treatment. Copyright 2005,, all rights reserved. Last update: July 18, 2005