Osteoporosis, Risk, Diagnosis And Treatment
Osteoporosis is defined by low bone mass and structural deterioration of bone tissue, which increases the risk of fracture. The World Health Organization (WHO) defines osteoporosis as having a spinal or hip bone mineral density (BMD) that is 2.5 standard deviations or more below the mean for healthy, young women (T-score of 2.5 or less) as measured by dual-energy x-ray absorptiometry (DEXA). 6 Osteopenia is defined as a spinal or hip BMD that is between one and two and a half standard deviations below the mean.
Osteoporosis is either clinically or radiographically diagnosed. Osteoporosis can cause low-impact fractures (falls at or below standing height) or fragility fractures (occurring spontaneously). A T-score of 2.5 or less, as determined by a central DEXA scan of the total hip, femoral neck, or lumbar spine, is most commonly used to diagnose osteoporosis. BMD can be assessed using quantitative computed tomography, but it is limited by radiation exposure and cost. Quantitative calcaneal ultrasonography and peripheral DEXA, which measure BMD in the heel, finger, and forearm and can effectively predict fracture risk, are more portable and less expensive than central DEXA. However, their results do not correlate well enough with central DEXA to be used as a diagnostic tool, and they are not helpful in monitoring treatment over time. Currently, biochemical markers of bone turnover in the serum or urine are not recommended for diagnosis.