Materiały źródłowe

• #1 Current Status of the Diagnosis and Management of Osteoporosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9408932/

  Osteoporosis is characterized by an imbalance between bone resorption and bone production. It is diagnosed through different methods such as bone densitometry and dual X-rays. […] The diagnosis of osteoporosis is mainly based on the evaluation of bone mass by bone densitometry (DEXA). Although osteoporosis is more than a bone densitometry value, this evaluation allows for the quantification of bone tissue, which is used as a diagnostic criterion and is considered a predictive value for the risk of fracture, which makes it the best method for determining the rate of bone loss and as a reference point for the evolutionary control of the disease. […] According to the WHO Expert Committee, the classification of BMD values is as follows: (i) normal: BMD 1 SD t-score; (ii) osteopenia: BMD between 1 SD and 2.5 SD t-score; (iii) osteoporosis: BMD 2.5 SD t-score; and (iv) established osteoporosis: BMD 2.5 SD t-score + fragility fracture.

• #2 Current Status of the Diagnosis and Management of Osteoporosis

  https://www.mdpi.com/1422-0067/23/16/9465

  Osteoporosis has been defined as the silent disease of the 21st century, becoming a public health risk due to its severity, chronicity and progression and affecting mainly postmenopausal women and older adults. Osteoporosis is characterized by an imbalance between bone resorption and bone production. It is diagnosed through different methods such as bone densitometry and dual X-rays. […] Nowadays, the diagnosis of osteoporosis is mainly based on the evaluation of bone mass by bone densitometry (DEXA). Although osteoporosis is more than a bone densitometry value, this evaluation allows for the quantification of bone tissue, which is used as a diagnostic criterion and is considered a predictive value for the risk of fracture, which makes it the best method for determining the rate of bone loss and as a reference point for the evolutionary control of the disease.

• #3 Osteoporosis Diagnosis and Prevention | UT Medical Center

  https://www.utmedicalcenter.org/treatments/osteoporosis-diagnosis-and-prevention

  Osteoporosis is often called a silent disease, meaning it can go undetected until it causes serious injury or significant skeletal damage. […] So far, the only test that can detect osteoporosis is a bone mineral density test, or DEXA scan. This is a painless scan that uses low-dose x-rays to measure calcium and other minerals in an area of bone.

• #4 Diagnosis | Osteoporosis Canada

  https://osteoporosis.ca/diagnosis/

  Osteoporosis often goes undiagnosed until a bone fractures, and is therefore commonly referred to as the silent thief. At this point, the disease is already fairly advanced. […] Because loss of bone mass occurs over a number of years, and many people dont experience symptoms or signs of the disease until its too late, early detection of bone loss is critical in preventing osteoporotic fractures. […] Osteoporosis Canada recommends combining the results of Bone Mineral Density (BMD) testing with some very important clinical risk factors. This leads to a much better and more accurate method of predicting a persons risk of fracture. As a result, the treatment of osteoporosis has now shifted from just treating BMD test results to treating people with a high fracture risk. […] Because the first warning sign of osteoporosis is frequently a fracture, it is often called the silent thief as it literally steals bone mass without giving any indication of doing so whatsoever, until a fracture occurs. By successfully identifying individuals at high fracture risk and treating them with effective medications, we can succeed in making this goal a reality.

• #5 Diagnosis | International Osteoporosis Foundation

  https://www.osteoporosis.foundation/health-professionals/diagnosis

  Men and women over 60-years-old are at higher risk of osteoporosis than younger people. Nevertheless, it is possible to have osteopenia (low bone mass) or osteoporosis at a much earlier age. […] An evaluation of risk factors for osteoporosis combined with a thorough medical history that includes information on any recent fractures is the first step toward a diagnosis and should indicate whether a bone mineral density (BMD) test is necessary or not. […] The most commonly used BMD test technique is described below, however, a number of different types of test options are available. […] Bone mineral density (BMD) test must be measured by more specialised techniques. The most commonly used BMD test is a densitometric technique called DXA (dual-energy X-ray absorptiometry), which can be measured in vivo and has been validated by many studies for fracture risk assessment.

• #6 Bone Density Test, Osteoporosis Screening & T-score Interpretation

  https://www.bonehealthandosteoporosis.org/patients/diagnosis-information/bone-density-examtesting/

  Are you a woman age 65 years or older, a man age 70 years or older, or have you broken a bone (had a fracture) since age 50 years? If you answered “yes” to any of these questions, you should talk to your healthcare provider about getting a bone density test. […] A bone density test is a measurement of how much mineral, such as calcium, you have in your bones. The most common and most versatile test is with dual-energy X-ray absorptiometry (DXA). This is used to diagnose osteoporosis BEFORE you break a bone, help to estimate your chances of breaking a bone in the future, and monitor the effectiveness of osteoporosis treatments. […] There are 3 ways that osteoporosis can be diagnosed. For each of these, confirmation of the diagnosis requires an evaluation to be sure there is no other disease or condition that appears to be osteoporosis but is not.

• #7 Diagnosis | International Osteoporosis Foundation

  https://www.osteoporosis.foundation/health-professionals/diagnosis

  For DXA scans, the World Health Organization has defined a number of threshold values for osteoporosis. […] Diagnosis of osteoporosis relies on its operational definition, which is when an individual’s T-score for BMD at the femoral neck is equal to or more than 2.5 SDs below the reference value. […] Bone density testing by DXA is a quantitative, non-invasive, comparatively inexpensive, convenient diagnostic procedure for osteoporosis. […] The limitations of DXA for identifying individuals who will experience a fragility fracture led to the development of the FRAX calculator, which integrates BMD with other, at least partly BMD-independent risk factors. […] Moving forwards, new diagnostic modalities are required to englobe all the aspects of fracture risk and can readily provide clinically meaningful information relating to the determinants of bone quality.

• #8 Osteoporosis Workup: Approach Considerations, Laboratory Studies, Biochemical Markers of Bone Turnover

  https://emedicine.medscape.com/article/330598-workup

  The International Osteoporosis Foundation (IOF) and the International Federation of Clinical Chemistry (IFCC) Bone Marker Standards Working Group have identified P1NP and CTX-1 in serum to be the reference markers of bone turnover for bone formation and bone resorption, respectively, for the fracture risk prediction and monitoring of osteoporosis treatment. […] DXA is currently the criterion standard for the evaluation of BMD. […] DXA is used to calculate BMD at the lumbar spine, hip, and proximal femur. […] The WHO diagnostic classification can be applied only to DXA at the femoral neck, total femur, lumbar spine, and the 33% radius region of interest measured by DXA or pDXA devices utilizing a validated young-adult reference database. […] QCT scanning may be useful in identifying fractures. It can be used to identify not only the fracture line but also areas of callus formation and sclerosis, consistent with healing fracture.

• #9 Bone Density Test, Osteoporosis Screening & T-score Interpretation

  https://www.bonehealthandosteoporosis.org/patients/diagnosis-information/bone-density-examtesting/

  The output of a DXA test is a number called a T-score. Normal is zero (0). The more negative the number, the weaker your bones and the more likely they are to break. If your T-score is -2.5 or below (such as -3.0), then you have osteoporosis, assuming there is no other reason for you to have such a low T-score. […] If you are over the age of 50 years and have had a fracture of the spine, hip, wrist, humerus (shoulder), rib, and/or pelvis, then you probably have osteoporosis. A fracture of the spine or hip means osteoporosis regardless of your T-score. […] If your 10-year probability of major osteoporotic fracture (meaning a fracture of the spine, hip, shoulder, or forearm) is 20% or more, or the 10-year probability of hip fracture is 3% or more, then a diagnosis of osteoporosis can be made.

• #10 Diagnosis | International Osteoporosis Foundation

  https://www.osteoporosis.foundation/patients/diagnosis

  Different types of BMD tests are available, but the most commonly used and recommended method is called DXA, which stands for dual-energy X-ray absorptiometry. […] The T-score on your bone density report shows how much your bone mass differs from the bone mass of an average healthy adult in their twenties. […] The T-score is measured in standard deviations (SD) and defines whether your bone mass is in the normal range, or whether you have osteopenia (an intermediate stage of bone loss between normal bone density and osteoporosis) or osteoporosis (a T-score of -2.5 or lower). […] If the results of your BMD test show osteopenia or osteoporosis, it does not automatically mean that you will have a fracture. There are lifestyle changes and a number of available therapies that your doctor might prescribe to slow down bone loss and help prevent fractures. […] There are a number of other methods for diagnosing osteoporosis, however, these are most often used in clinical trials and research as opposed to routine diagnosis. These include radiological assessments and Bone Turnover Markers (BTM).

• #11 Current Status of the Diagnosis and Management of Osteoporosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9408932/

  Osteoporosis is characterized by an imbalance between bone resorption and bone production. It is diagnosed through different methods such as bone densitometry and dual X-rays. […] The diagnosis of osteoporosis is mainly based on the evaluation of bone mass by bone densitometry (DEXA). Although osteoporosis is more than a bone densitometry value, this evaluation allows for the quantification of bone tissue, which is used as a diagnostic criterion and is considered a predictive value for the risk of fracture, which makes it the best method for determining the rate of bone loss and as a reference point for the evolutionary control of the disease. […] According to the WHO Expert Committee, the classification of BMD values is as follows: (i) normal: BMD 1 SD t-score; (ii) osteopenia: BMD between 1 SD and 2.5 SD t-score; (iii) osteoporosis: BMD 2.5 SD t-score; and (iv) established osteoporosis: BMD 2.5 SD t-score + fragility fracture.

• #12 Current Status of the Diagnosis and Management of Osteoporosis

  https://www.mdpi.com/1422-0067/23/16/9465

  According to the WHO Expert Committee, the classification of BMD values is as follows: (i) normal: BMD > -1 SD t-score; (ii) osteopenia: BMD between -1 SD and -2.5 SD t-score; (iii) osteoporosis: BMD < -2.5 SD t-score; and (iv) established osteoporosis: BMD < -2.5 SD t-score + fragility fracture. [...] Dual X-ray absorptiometry is the most recommended technique for the diagnosis of osteoporosis since it can predict the risk of fracture, indicate the treatment or monitor its effect. [...] General blood and urine tests provide information on the general health status and on the existence of elements causing secondary osteoporosis. [...] The most commonly used resorption markers that measure osteoclast activity are: (i) Pyridinolines (Pir) and deoxypyridinoline (Dpir), which link collagen molecules in the bone matrix through covalent bonds, thus forming fibrils; and (ii) ICTP (C-terminal telopeptide of type I collagen), β-CTX (β-CrossLaps) and NTX (N-terminal telopeptide of type I collagen), which are peptides released during the process of bone resorption. [...] Therefore, it is essential to assess the risk of fracture, which is performed by considering the degree of osteoporosis obtained by densitometry according to the WHO Expert Committee.

• #13

  https://www.nhs.uk/conditions/osteoporosis/

  Osteoporosis is a health condition that weakens bones, making them fragile and more likely to break. It develops slowly over several years and is often only diagnosed when a fall or sudden impact causes a bone to break (fracture). […] If your doctor suspects you have osteoporosis, they can work out your future risk of breaking a bone using an online programme, such as FRAX or Q-Fracture. […] They may also refer you for a bone density scan to measure your bone strength. It’s a short, painless procedure that takes 10 to 20 minutes, depending on the part of the body being scanned. […] The difference is calculated as a standard deviation (SD) and is called a T score. […] A T score of: above -1 SD is normal; between -1 and -2.5 SD shows bone loss and is defined as osteopenia; below -2.5 shows bone loss and is defined as osteoporosis.

• #14 Current Status of the Diagnosis and Management of Osteoporosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9408932/

  Osteoporosis is characterized by an imbalance between bone resorption and bone production. It is diagnosed through different methods such as bone densitometry and dual X-rays. […] The diagnosis of osteoporosis is mainly based on the evaluation of bone mass by bone densitometry (DEXA). Although osteoporosis is more than a bone densitometry value, this evaluation allows for the quantification of bone tissue, which is used as a diagnostic criterion and is considered a predictive value for the risk of fracture, which makes it the best method for determining the rate of bone loss and as a reference point for the evolutionary control of the disease. […] According to the WHO Expert Committee, the classification of BMD values is as follows: (i) normal: BMD 1 SD t-score; (ii) osteopenia: BMD between 1 SD and 2.5 SD t-score; (iii) osteoporosis: BMD 2.5 SD t-score; and (iv) established osteoporosis: BMD 2.5 SD t-score + fragility fracture.

• #15 Diagnosis and Management of Osteoporosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0815/p261.html

  The U.S. Preventive Services Task Force (USPSTF) recommends screening all women 65 years and older. DEXA of the hip and lumbar spine is the preferred assessment method. The USPSTF also advises screening women younger than 65 years whose 10-year fracture risk is greater than or equal to that of a 65-year-old white woman without additional risk factors. […] The USPSTF found insufficient evidence to recommend routine screening for osteoporosis in men. Men with a minimal trauma fracture who are older than 50 years or those with secondary causes associated with bone loss could be considered for screening. The National Osteoporosis Foundation also recommends screening all men 70 years and older, based on the assumption that this group has a similar osteoporotic fracture risk and treatment effectiveness as 65-year-old white women.

• #16 Overview of Osteoporosis Diagnosis and Treatment for Adults

  https://www.health.ny.gov/publications/1989/index.htm

  Osteoporosis, based on a bone mineral density test, is a „silent” risk factor for fracture just as hypertension is for stroke. Nearly one in two women and one in four men will experience an osteoporosis related fracture after age 50. Risk factors for osteoporosis include: a family history of osteoporosis and/or fracture; prior fracture after age 50; height loss, steroid medications, and rheumatoid arthritis, among others. […] Perform evaluation for osteoporosis using Bone Mineral Density (BMD) testing for the following at-risk populations: Women or men who have broken bones, with or without trauma after age 50; All women 65 and older; All men 70 and older; Women younger than 65 who have reached menopause and have risk factors for osteoporosis; Men age 50 to 69 with risk factors for osteoporosis.

• #17 Recommendation: Osteoporosis to Prevent Fractures: Screening | United States Preventive Services Taskforce

  https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosis-screening

  Women 65 years or older: The USPSTF recommends screening for osteoporosis to prevent osteoporotic fractures in women 65 years or older. […] Postmenopausal women younger than 65 years with 1 or more risk factors for osteoporosis: The USPSTF recommends screening for osteoporosis to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk for an osteoporotic fracture as estimated by clinical risk assessment. […] The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men. […] To achieve the benefit of screening to reduce morbidity and mortality from fractures, women found to have osteoporosis should be further evaluated, counseled, and, if appropriate, prescribed evidence-based management.

• #18 Overview of Osteoporosis Diagnosis and Treatment for Adults

  https://www.health.ny.gov/publications/1989/index.htm

  Osteoporosis, based on a bone mineral density test, is a „silent” risk factor for fracture just as hypertension is for stroke. Nearly one in two women and one in four men will experience an osteoporosis related fracture after age 50. Risk factors for osteoporosis include: a family history of osteoporosis and/or fracture; prior fracture after age 50; height loss, steroid medications, and rheumatoid arthritis, among others. […] Perform evaluation for osteoporosis using Bone Mineral Density (BMD) testing for the following at-risk populations: Women or men who have broken bones, with or without trauma after age 50; All women 65 and older; All men 70 and older; Women younger than 65 who have reached menopause and have risk factors for osteoporosis; Men age 50 to 69 with risk factors for osteoporosis.

• #19 Osteoporosis Diagnosis, Treatment of Wisconsin

  https://www.froedtert.com/endocrinology/osteoporosis/treatment

  People with osteoporosis dont experience symptoms until they have a fracture and they may not know they have the disease until they break a bone or they have a bone density test. […] Dual energy X-ray absorptiometry (DXA) is the technique most commonly used for measuring bone mineral density. […] DXA testing is recommended for: Women over age 65, Postmenopausal women under age 65 with additional risk factors for osteoporosis, Patients with fragility fractures (fractures occurring without much trauma), Patients with diseases associated with osteoporosis or on medications associated with osteoporosis, Men over age 70, Patients on osteoporosis treatment (to monitor response). […] In addition to DXA, patients typically undergo a laboratory evaluation (blood and urine) to check for problems that may cause bone loss.

• #20 Recommendation: Osteoporosis to Prevent Fractures: Screening | United States Preventive Services Taskforce

  https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosis-screening

  Women 65 years or older: The USPSTF recommends screening for osteoporosis to prevent osteoporotic fractures in women 65 years or older. […] Postmenopausal women younger than 65 years with 1 or more risk factors for osteoporosis: The USPSTF recommends screening for osteoporosis to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk for an osteoporotic fracture as estimated by clinical risk assessment. […] The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men. […] To achieve the benefit of screening to reduce morbidity and mortality from fractures, women found to have osteoporosis should be further evaluated, counseled, and, if appropriate, prescribed evidence-based management.

• #21 Diagnosis and Management of Osteoporosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0815/p261.html

  The U.S. Preventive Services Task Force (USPSTF) recommends screening all women 65 years and older. DEXA of the hip and lumbar spine is the preferred assessment method. The USPSTF also advises screening women younger than 65 years whose 10-year fracture risk is greater than or equal to that of a 65-year-old white woman without additional risk factors. […] The USPSTF found insufficient evidence to recommend routine screening for osteoporosis in men. Men with a minimal trauma fracture who are older than 50 years or those with secondary causes associated with bone loss could be considered for screening. The National Osteoporosis Foundation also recommends screening all men 70 years and older, based on the assumption that this group has a similar osteoporotic fracture risk and treatment effectiveness as 65-year-old white women.

• #22 Osteoporosis: Diagnosis, Treatment, and Steps to Take

  https://www.niams.nih.gov/health-topics/osteoporosis/diagnosis-treatment-and-steps-to-take

  Doctors usually diagnose osteoporosis during routine screening for the disease. The U.S. Preventive Services Task Force recommends screening for: […] In addition, your doctor may order a test that measures your bone mineral density (BMD) in a specific area of your bone, usually your spine and hip. BMD testing can be used to: […] The most common test for measuring bone mineral density is dual-energy x-ray absorptiometry (DXA). […] Your doctor will compare your BMD test results to the average bone density of young, healthy people and to the average bone density of other people of your age, sex, and race. If your BMD is below a certain level, you will be diagnosed with osteoporosis and your doctor may recommend both lifestyle approaches to promote bone health and medications to lower your chance of breaking a bone. […] Sometimes, your doctor may recommend a quantitative ultrasound (QUS) of the heel. This is a test that evaluates bone but does not measure BMD. If the QUS indicates that you have bone loss, you will still need a DXA test to diagnose bone loss and osteoporosis.

• #23 Osteoporosis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/85

  Investigations to consider include the Fracture Risk Assessment Tool (FRAX), vertebral fracture assessment (DXA-VFA), trabecular bone score, quantitative ultrasound (QUS) of the heel, x-ray (wrist, heel, spine, and hip), quantitative CT, and biochemical markers of bone resorption and bone formation.

• #24 Diagnosis | International Osteoporosis Foundation

  https://www.osteoporosis.foundation/health-professionals/diagnosis

  For DXA scans, the World Health Organization has defined a number of threshold values for osteoporosis. […] Diagnosis of osteoporosis relies on its operational definition, which is when an individual’s T-score for BMD at the femoral neck is equal to or more than 2.5 SDs below the reference value. […] Bone density testing by DXA is a quantitative, non-invasive, comparatively inexpensive, convenient diagnostic procedure for osteoporosis. […] The limitations of DXA for identifying individuals who will experience a fragility fracture led to the development of the FRAX calculator, which integrates BMD with other, at least partly BMD-independent risk factors. […] Moving forwards, new diagnostic modalities are required to englobe all the aspects of fracture risk and can readily provide clinically meaningful information relating to the determinants of bone quality.

• #25 Diagnosis and Tests for Osteoporosis | American Geriatrics Society | HealthInAging.org

  https://www.healthinaging.org/a-z-topic/osteoporosis/tests

  Some people need to be screened for bone density problems and osteoporosis. […] Screening involves a DEXA (dual-energy x-ray absorptiometry) scan, which is safe and painless. […] The following groups need a DEXA scan: Women over the age of 65 years or who had early menopause. […] How often a person gets an osteoporosis screening depends on their age, baseline bone density, and other risk factors. […] When you see your healthcare professional about osteoporosis, they will do the following to diagnose the disease. […] Order a test called a DEXA scan. […] Determine a FRAX score. This score comes from a fracture risk assessment tool. The tool predicts the 10-year risk of a hip or other major fracture due to osteoporosis using bone mineral density along with other risk factors.

• #26 Osteoporosis Diagnosis, Treatment of Wisconsin

  https://www.froedtert.com/endocrinology/osteoporosis/treatment

  Vertebral fracture assessment (VFA) is done for selected patients along with the DXA test. This consists of evaluating DXA images of the spine to identify compression fractures of the vertebrae. When combined with the bone mineral density test, VFA helps determine the person’s risk of future fracture.

• #27 Osteoporosis Workup: Approach Considerations, Laboratory Studies, Biochemical Markers of Bone Turnover

  https://emedicine.medscape.com/article/330598-workup

  The International Osteoporosis Foundation (IOF) and the International Federation of Clinical Chemistry (IFCC) Bone Marker Standards Working Group have identified P1NP and CTX-1 in serum to be the reference markers of bone turnover for bone formation and bone resorption, respectively, for the fracture risk prediction and monitoring of osteoporosis treatment. […] DXA is currently the criterion standard for the evaluation of BMD. […] DXA is used to calculate BMD at the lumbar spine, hip, and proximal femur. […] The WHO diagnostic classification can be applied only to DXA at the femoral neck, total femur, lumbar spine, and the 33% radius region of interest measured by DXA or pDXA devices utilizing a validated young-adult reference database. […] QCT scanning may be useful in identifying fractures. It can be used to identify not only the fracture line but also areas of callus formation and sclerosis, consistent with healing fracture.

• #28 Current Status of the Diagnosis and Management of Osteoporosis

  https://www.mdpi.com/1422-0067/23/16/9465

  According to the WHO Expert Committee, the classification of BMD values is as follows: (i) normal: BMD > -1 SD t-score; (ii) osteopenia: BMD between -1 SD and -2.5 SD t-score; (iii) osteoporosis: BMD < -2.5 SD t-score; and (iv) established osteoporosis: BMD < -2.5 SD t-score + fragility fracture. [...] Dual X-ray absorptiometry is the most recommended technique for the diagnosis of osteoporosis since it can predict the risk of fracture, indicate the treatment or monitor its effect. [...] General blood and urine tests provide information on the general health status and on the existence of elements causing secondary osteoporosis. [...] The most commonly used resorption markers that measure osteoclast activity are: (i) Pyridinolines (Pir) and deoxypyridinoline (Dpir), which link collagen molecules in the bone matrix through covalent bonds, thus forming fibrils; and (ii) ICTP (C-terminal telopeptide of type I collagen), β-CTX (β-CrossLaps) and NTX (N-terminal telopeptide of type I collagen), which are peptides released during the process of bone resorption. [...] Therefore, it is essential to assess the risk of fracture, which is performed by considering the degree of osteoporosis obtained by densitometry according to the WHO Expert Committee.

• #29 Diagnosis | International Osteoporosis Foundation

  https://www.osteoporosis.foundation/patients/diagnosis

  If you have risk factors for osteoporosis it is important that you ask your doctor for a bone health assessment. […] As part of your bone health check-up your doctor should take a complete medical history that includes information on any recent fractures. As well your doctor will likely estimate your future risk by using a fracture risk assessment tool such as FRAX. […] Depending on the results of your fracture risk assessment, a Bone Mineral Density (BMD) test may be recommended. In some countries (e.g. U.S.A.), BMD testing is recommended for all women and men at age 65, regardless of whether they have risk factors. […] BMD testing is a safe, fast and painless method to measure whether you have osteoporosis or how likely you are to develop it in the future. […] Traditional X-rays used to identify broken bones (for example spine fractures) cannot measure BMD. BMD has to be measured by more specialised techniques.

• #30 Osteoporosis Diagnosis for Long-term Bone Health | BeamMed Inc.

  https://www.beammed.com/osteoporosis-diagnosis-for-long-term-bone-health/

  Bone density tests are an important element in helping evaluate bone health relating to risks of fractures and in assessing osteoporosis development. […] The tests are used by physicians to help them diagnose and monitor osteoporosis and are an essential tool in the fight against osteoporosis. […] Physicians use bone density tests in association with consideration of a variety of clinical risk factors, including: Sex, age, height and weight of the patient Previous fractures Hip fractures among parents Smoking habits Associated conditions such as rheumatoid arthritis Alcohol consumption. […] Traditionally, Dual Energy X-ray Absorptiometry (DXA) technology is used for bone density tests. It provides an assessment the amount of minerals in the bones. Bone mineral density loss, identified through a DXA bone density test, provides an indication of bone status.

• #31 Osteoporosis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/85

  Osteoporosis is asymptomatic until fracture occurs. […] Diagnosis is based on a history of prior fragility fracture or low bone mineral density, which is defined as a T-score -2.5. […] Screening is based on individual risk factors, including female sex, maternal history of fragility fracture/osteoporosis, older age, low body mass index (20 kg/m), diabetes, rheumatoid arthritis, sarcopenia, androgen deprivation treatment (in males), aromatase inhibitor treatment (in females), corticosteroid use, tobacco use, and excessive alcohol intake. […] Key diagnostic factors include the presence of risk factors and being asymptomatic. […] Other diagnostic factors include back pain, kyphosis, height loss, and vertebral tenderness. […] 1st investigations to order include dual-energy x-ray absorptiometry (DXA)-bone mineral density (BMD).

• #32 Diagnosis | International Osteoporosis Foundation

  https://www.osteoporosis.foundation/health-professionals/diagnosis

  For DXA scans, the World Health Organization has defined a number of threshold values for osteoporosis. […] Diagnosis of osteoporosis relies on its operational definition, which is when an individual’s T-score for BMD at the femoral neck is equal to or more than 2.5 SDs below the reference value. […] Bone density testing by DXA is a quantitative, non-invasive, comparatively inexpensive, convenient diagnostic procedure for osteoporosis. […] The limitations of DXA for identifying individuals who will experience a fragility fracture led to the development of the FRAX calculator, which integrates BMD with other, at least partly BMD-independent risk factors. […] Moving forwards, new diagnostic modalities are required to englobe all the aspects of fracture risk and can readily provide clinically meaningful information relating to the determinants of bone quality.

• #33 Bone Density Test, Osteoporosis Screening & T-score Interpretation

  https://www.bonehealthandosteoporosis.org/patients/diagnosis-information/bone-density-examtesting/

  The output of a DXA test is a number called a T-score. Normal is zero (0). The more negative the number, the weaker your bones and the more likely they are to break. If your T-score is -2.5 or below (such as -3.0), then you have osteoporosis, assuming there is no other reason for you to have such a low T-score. […] If you are over the age of 50 years and have had a fracture of the spine, hip, wrist, humerus (shoulder), rib, and/or pelvis, then you probably have osteoporosis. A fracture of the spine or hip means osteoporosis regardless of your T-score. […] If your 10-year probability of major osteoporotic fracture (meaning a fracture of the spine, hip, shoulder, or forearm) is 20% or more, or the 10-year probability of hip fracture is 3% or more, then a diagnosis of osteoporosis can be made.

• #34 Overview of Osteoporosis Diagnosis and Treatment for Adults

  https://www.health.ny.gov/publications/1989/index.htm

  Select the following candidates for treatment with FDA-approved osteoporosis medications: All men as well as postmenopausal women who present with atraumatic vertebral or hip fracture; Men and women with T-score -2.5, at the femoral neck or spine, after appropriate evaluation to exclude secondary causes; Low bone mass (T-score between -1.0 and -2.5 at the femoral neck or spine) and a 10-year probability of a hip fracture 3% or a 10-year probability of a major osteoporosis-related fracture 20% based on the US-adapted WHO algorithm in patients over 50 and not currently on osteoporosis medication.

• #35 Bone Density Test, Osteoporosis Screening & T-score Interpretation

  https://www.bonehealthandosteoporosis.org/patients/diagnosis-information/bone-density-examtesting/

  The output of a DXA test is a number called a T-score. Normal is zero (0). The more negative the number, the weaker your bones and the more likely they are to break. If your T-score is -2.5 or below (such as -3.0), then you have osteoporosis, assuming there is no other reason for you to have such a low T-score. […] If you are over the age of 50 years and have had a fracture of the spine, hip, wrist, humerus (shoulder), rib, and/or pelvis, then you probably have osteoporosis. A fracture of the spine or hip means osteoporosis regardless of your T-score. […] If your 10-year probability of major osteoporotic fracture (meaning a fracture of the spine, hip, shoulder, or forearm) is 20% or more, or the 10-year probability of hip fracture is 3% or more, then a diagnosis of osteoporosis can be made.

• #36 Osteoporosis Workup: Approach Considerations, Laboratory Studies, Biochemical Markers of Bone Turnover

  https://emedicine.medscape.com/article/330598-workup

  However, densitometric criteria alone should not be used to diagnose osteoporosis in children and adolescents. Rather, such a diagnosis in this population must be based on a low bone mineral content (BMC) or BMD in conjunction with a clinically significant fracture history. […] Laboratory studies are used to exclude secondary causes of osteoporosis and to ensure that the selection of pharmacologic therapy for osteoporosis is appropriate, based on kidney function and serum calcium levels. […] An important study by Tannenbaum evaluated 173 healthy women (ages 46-87 years) for secondary causes of osteoporosis and found that 55 (32%) had a previously undiagnosed disorder of bone or mineral metabolism. […] BSAP is nonspecific and can be mildly elevated in patients with fractures. In addition, patients with hyperparathyroidism, Paget disease, or osteomalacia can have elevations of BSAP.

• #37 Osteoporosis Guidelines: Screening, Diagnosis, Treatment

  https://emedicine.medscape.com/article/330598-guidelines

  The 2020 update of the American Association of Clinical Endocrinologists (AACE) guidelines provides the following criteria for the diagnosis of osteoporosis in postmenopausal women: T-score 2.5 or below in the lumbar spine, femoral neck, total proximal femur, or 1/3 radius. […] The National Osteoporosis Guideline Group (NOGG) recommends considering the following as routine in the investigation of osteoporosis/fragility fractures: Clinical history, Physical examination including measurement of height and assessment of thoracic kyphosis, Complete blood cell count, Erythrocyte sedimentation rate or C-reactive protein, Serum calcium, albumin, creatinine, phosphate, alkaline phosphatase, and liver transaminases, Serum 25-hydroxyvitamin D, Thyroid function tests. […] The NOGG recommends that clinicians consider performing the following studies, as indicated: Serum electrophoresis, immunoglobulins, and free light chain assay, Plasma parathyroid hormone (PTH), if primary hyperparathyroidism suspected, Serum testosterone, sex hormone-binding globulin, follicle-stimulating hormone, luteinizing hormone, 24-h urinary free cortisol/overnight dexamethasone suppression test, Serum prolactin, Serum magnesium if hypocalcemic, Tissue transglutaminase antibodies, endomysial antibodies (celiac disease screen), Urinary calcium excretion, Markers of bone turnover (eg, carboxyterminal collagen crosslinks [CTX], P1NP), Lateral radiographs of lumbar and thoracic spine or DXA-based lateral vertebral imaging, Bone densitometry (DXA) if indicated by FRAX assessment and/or required for BMD monitoring, Isotope bone scan.

• #38 Diagnosis, Screening and Treatment of Osteoporosis – A Review – Biomedical and Pharmacology Journal

  https://biomedpharmajournal.org/vol14no2/diagnosis-screening-and-treatment-of-osteoporosis-a-review/

  Osteoporosis is diagnosed based on the fragility fractures, low bone mineral density assessed by DEXA scan. […] Clinicians must take proper measures in finding out the patients who are at higher risk of Osteoporosis and providing treatment by either diagnosing or by screening the previous history of fracture risk in the patients. […] Till 1993 there were no proper diagnosing methods for Osteoporosis. The incidence of fragility fractures was the only indication for the diagnosis of Osteoporosis. After the year 1994 WHO established definitions for Osteoporosis to help researchers and physicians to categorize the degree of bone loss among the patients mentioned in Table 2. The most common and the standard test for the evaluation of Osteoporosis are the measurement of: Serum calcium, Renal function, Vitamin D3 levels, Alkaline phosphatase, Parathyroid Hormone levels, Thyroid function test.

• #39 Osteoporosis Workup: Approach Considerations, Laboratory Studies, Biochemical Markers of Bone Turnover

  https://emedicine.medscape.com/article/330598-workup

  However, densitometric criteria alone should not be used to diagnose osteoporosis in children and adolescents. Rather, such a diagnosis in this population must be based on a low bone mineral content (BMC) or BMD in conjunction with a clinically significant fracture history. […] Laboratory studies are used to exclude secondary causes of osteoporosis and to ensure that the selection of pharmacologic therapy for osteoporosis is appropriate, based on kidney function and serum calcium levels. […] An important study by Tannenbaum evaluated 173 healthy women (ages 46-87 years) for secondary causes of osteoporosis and found that 55 (32%) had a previously undiagnosed disorder of bone or mineral metabolism. […] BSAP is nonspecific and can be mildly elevated in patients with fractures. In addition, patients with hyperparathyroidism, Paget disease, or osteomalacia can have elevations of BSAP.

• #40 Osteoporosis Guidelines: Screening, Diagnosis, Treatment

  https://emedicine.medscape.com/article/330598-guidelines

  The 2020 update of the American Association of Clinical Endocrinologists (AACE) guidelines provides the following criteria for the diagnosis of osteoporosis in postmenopausal women: T-score 2.5 or below in the lumbar spine, femoral neck, total proximal femur, or 1/3 radius. […] The National Osteoporosis Guideline Group (NOGG) recommends considering the following as routine in the investigation of osteoporosis/fragility fractures: Clinical history, Physical examination including measurement of height and assessment of thoracic kyphosis, Complete blood cell count, Erythrocyte sedimentation rate or C-reactive protein, Serum calcium, albumin, creatinine, phosphate, alkaline phosphatase, and liver transaminases, Serum 25-hydroxyvitamin D, Thyroid function tests. […] The NOGG recommends that clinicians consider performing the following studies, as indicated: Serum electrophoresis, immunoglobulins, and free light chain assay, Plasma parathyroid hormone (PTH), if primary hyperparathyroidism suspected, Serum testosterone, sex hormone-binding globulin, follicle-stimulating hormone, luteinizing hormone, 24-h urinary free cortisol/overnight dexamethasone suppression test, Serum prolactin, Serum magnesium if hypocalcemic, Tissue transglutaminase antibodies, endomysial antibodies (celiac disease screen), Urinary calcium excretion, Markers of bone turnover (eg, carboxyterminal collagen crosslinks [CTX], P1NP), Lateral radiographs of lumbar and thoracic spine or DXA-based lateral vertebral imaging, Bone densitometry (DXA) if indicated by FRAX assessment and/or required for BMD monitoring, Isotope bone scan.

• #41 Osteoporosis Workup: Approach Considerations, Laboratory Studies, Biochemical Markers of Bone Turnover

  https://emedicine.medscape.com/article/330598-workup

  The International Osteoporosis Foundation (IOF) and the International Federation of Clinical Chemistry (IFCC) Bone Marker Standards Working Group have identified P1NP and CTX-1 in serum to be the reference markers of bone turnover for bone formation and bone resorption, respectively, for the fracture risk prediction and monitoring of osteoporosis treatment. […] DXA is currently the criterion standard for the evaluation of BMD. […] DXA is used to calculate BMD at the lumbar spine, hip, and proximal femur. […] The WHO diagnostic classification can be applied only to DXA at the femoral neck, total femur, lumbar spine, and the 33% radius region of interest measured by DXA or pDXA devices utilizing a validated young-adult reference database. […] QCT scanning may be useful in identifying fractures. It can be used to identify not only the fracture line but also areas of callus formation and sclerosis, consistent with healing fracture.

• #42 Osteoporosis | Bone Density Loss – Diagnosis, Evaluation and Treatment

  https://www.radiologyinfo.org/en/info/osteoporosis

  Osteoporosis may cause vertebral compression fractures in the spine; if painful, these fractures may be treated with vertebroplasty or kyphoplasty. […] To diagnose osteoporosis and assess your risk of fracture and determine your need for treatment, your doctor will most likely order a bone density scan. […] This exam is used to measure bone mineral density (BMD). […] The following procedures can be performed to determine bone fractures due to osteoporosis: Bone x-ray produces images of bones within the body, including the hand, wrist, arm, elbow, shoulder, foot, ankle, leg (shin), knee, thigh, hip, pelvis or spine. It aids in the diagnosis of fractured bones, which are sometimes a result of osteoporosis. […] CT scanning of the spine is performed to assess for alignment and fractures. It can be used to measure bone density and determine whether vertebral fractures are likely to occur.

• #43 Importance of Early Diagnosis and Treatment of Osteoporosis to Prevent Fractures

  https://www.ajmc.com/view/may06-2313ps181-s190

  Ordinary radiographs do not display sufficient sensitivity to diagnose osteoporosis until total BMD has declined by 50%. […] Consequently, dual-energy x-ray absorptiometry (DXA) has become the most widely used technique for assessing BMD. […] There is a consensus that BMD measurements should be considered in patients who have an increased risk for osteoporosis and in all women aged 65 and older. […] The value of universal screening, particularly in perimenopausal women, has not been established. […] The National Institutes of Health Consensus Panel suggests an individualized approach to treatment in perimenopausal women until solid evidence of the cost-effectiveness of routine BMD screening emerges. […] Currently, there is no accurate measure of overall bone strength. BMD, a frequently used proxy measurement, accounts for about 70% of bone strength. […] Although stable or increased BMD measurements and decreases in bone turnover are important surrogate markers, the clinically important endpoint is reduction in fracture.

• #44 Osteoporosis | Bone Density Loss – Diagnosis, Evaluation and Treatment

  https://www.radiologyinfo.org/en/info/osteoporosis

  Osteoporosis may cause vertebral compression fractures in the spine; if painful, these fractures may be treated with vertebroplasty or kyphoplasty. […] To diagnose osteoporosis and assess your risk of fracture and determine your need for treatment, your doctor will most likely order a bone density scan. […] This exam is used to measure bone mineral density (BMD). […] The following procedures can be performed to determine bone fractures due to osteoporosis: Bone x-ray produces images of bones within the body, including the hand, wrist, arm, elbow, shoulder, foot, ankle, leg (shin), knee, thigh, hip, pelvis or spine. It aids in the diagnosis of fractured bones, which are sometimes a result of osteoporosis. […] CT scanning of the spine is performed to assess for alignment and fractures. It can be used to measure bone density and determine whether vertebral fractures are likely to occur.

• #45 Osteoporosis Workup: Approach Considerations, Laboratory Studies, Biochemical Markers of Bone Turnover

  https://emedicine.medscape.com/article/330598-workup

  The International Osteoporosis Foundation (IOF) and the International Federation of Clinical Chemistry (IFCC) Bone Marker Standards Working Group have identified P1NP and CTX-1 in serum to be the reference markers of bone turnover for bone formation and bone resorption, respectively, for the fracture risk prediction and monitoring of osteoporosis treatment. […] DXA is currently the criterion standard for the evaluation of BMD. […] DXA is used to calculate BMD at the lumbar spine, hip, and proximal femur. […] The WHO diagnostic classification can be applied only to DXA at the femoral neck, total femur, lumbar spine, and the 33% radius region of interest measured by DXA or pDXA devices utilizing a validated young-adult reference database. […] QCT scanning may be useful in identifying fractures. It can be used to identify not only the fracture line but also areas of callus formation and sclerosis, consistent with healing fracture.

• #46 Osteoporosis | Bone Density Loss – Diagnosis, Evaluation and Treatment

  https://www.radiologyinfo.org/en/info/osteoporosis

  MRI of the spine is performed to evaluate vertebral fractures for evidence of underlying disease, such as cancer, and to assess if the fracture is old or new. […] A prescription is required for these medications and medical evaluation is required before treatment. […] Compression fractures in the vertebra can occur as a result of osteoporosis. In these cases, vertebroplasty and kyphoplasty, performed by a radiologist, may be an option to treat painful spine fractures.

• #47 Osteoporosis Workup: Approach Considerations, Laboratory Studies, Biochemical Markers of Bone Turnover

  https://emedicine.medscape.com/article/330598-workup

  SPECT scanning is helpful when accurate localization of skeletal lesions within large and/or anatomically complex bony structures is required. […] Quantitative ultrasonography (QUS) of the calcaneus is a low-cost portable screening tool. […] MRI is a very sensitive modality and is believed by some to be the diagnostic imaging method of choice in the detection of acute fractures, such as sacral fractures. […] Bone biopsy can help to exclude underlying pathologic conditions, such as mastocytosis, that may be responsible for presumed osteoporotic fracture.

• #48 Diagnosis | International Osteoporosis Foundation

  https://www.osteoporosis.foundation/patients/diagnosis

  Different types of BMD tests are available, but the most commonly used and recommended method is called DXA, which stands for dual-energy X-ray absorptiometry. […] The T-score on your bone density report shows how much your bone mass differs from the bone mass of an average healthy adult in their twenties. […] The T-score is measured in standard deviations (SD) and defines whether your bone mass is in the normal range, or whether you have osteopenia (an intermediate stage of bone loss between normal bone density and osteoporosis) or osteoporosis (a T-score of -2.5 or lower). […] If the results of your BMD test show osteopenia or osteoporosis, it does not automatically mean that you will have a fracture. There are lifestyle changes and a number of available therapies that your doctor might prescribe to slow down bone loss and help prevent fractures. […] There are a number of other methods for diagnosing osteoporosis, however, these are most often used in clinical trials and research as opposed to routine diagnosis. These include radiological assessments and Bone Turnover Markers (BTM).

• #49 Osteoporosis: Bone density scan (DXA/DEXA)

  https://theros.org.uk/information-and-support/osteoporosis/scans-tests-and-results/bone-density-scan-dxa/

  A bone density scan is not done to provide information about cancer, pain or osteoarthritis. […] The results of your scan give information about your bone density. Your bone density scan is just one part of assessing your bone strength. The scan results are usually put together with other information, including a fracture risk assessment. […] A fracture risk assessment is a questionnaire used by healthcare professionals to understand your bones strength. The most common fracture risk assessment is called FRAX. It will assess your chance of breaking a bone and if you would benefit from an osteoporosis medicine. […] The result of your bone density scan may be given as a number called a T-score. A T-score compares your bone density to the normal range found in young healthy adults: Normal (+1 to -1) – Your bone density is in the normal range for a young adult; Low bone density (-1 to -2.5) – Your bone density is slightly below the normal range for a young adult. This is also known as the osteopenia range. This score is expected in older adults; Osteoporosis (-2.5 and below) – Your bone density is much lower than the normal range for a young adult. This is also known as the osteoporosis range. […] Your doctor may suggest another bone density scan in the future. Bone density scans can be useful to monitor your bone strength, reassess if you would benefit from an osteoporosis medicine, support an osteoporosis medicine review.

• #50 DEXA Scan / Bone Density Test: A Patient’s Guide | HSS

  https://www.hss.edu/conditions_dxa-dexa-bone-density-test-patient-guide.asp

  Osteoporosis anywhere in your body is osteoporosis everywhere. The diagnosis is made using the lowest T-score. […] For people with low bone density, the FRAX (fracture risk assessment) tool, is often included in the report. […] Osteoarthritis degenerative joint disease is unrelated to osteoporosis (this is a common point of confusion). […] Unlike various cancer screening modalities, there is no upper age limit for bone density screening.

• #51 Patient education: Bone density testing (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/bone-density-testing-beyond-the-basics/print

  The results of a bone density test are expressed either as a „T” or a „Z” score. T-scores represent numbers that compare the condition of your bones with those of an average young person with healthy bones. […] Osteoporosis — People with osteoporosis have a T-score of -2.5 or less. Larger numbers (eg, -3.0) indicate lower bone density because this is a negative number. […] The lower the bone density, the greater the risk of fracture. If you discover that you have osteoporosis, there are several things you can do to reduce the chances that you will break a bone. […] DO I NEED TO HAVE BONE DENSITY TESTING AGAIN? […] Even if your bone density test shows that you do not have osteoporosis today, you may need to have the test again. How long to wait between tests depends on your initial bone density results and whether you have risk factors that represent an ongoing threat to your bones.

• #52 Importance of Early Diagnosis and Treatment of Osteoporosis to Prevent Fractures

  https://www.ajmc.com/view/may06-2313ps181-s190

  Ordinary radiographs do not display sufficient sensitivity to diagnose osteoporosis until total BMD has declined by 50%. […] Consequently, dual-energy x-ray absorptiometry (DXA) has become the most widely used technique for assessing BMD. […] There is a consensus that BMD measurements should be considered in patients who have an increased risk for osteoporosis and in all women aged 65 and older. […] The value of universal screening, particularly in perimenopausal women, has not been established. […] The National Institutes of Health Consensus Panel suggests an individualized approach to treatment in perimenopausal women until solid evidence of the cost-effectiveness of routine BMD screening emerges. […] Currently, there is no accurate measure of overall bone strength. BMD, a frequently used proxy measurement, accounts for about 70% of bone strength. […] Although stable or increased BMD measurements and decreases in bone turnover are important surrogate markers, the clinically important endpoint is reduction in fracture.

• #53 Recommendation: Osteoporosis to Prevent Fractures: Screening | United States Preventive Services Taskforce

  https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosis-screening

  Women 65 years or older: The USPSTF recommends screening for osteoporosis to prevent osteoporotic fractures in women 65 years or older. […] Postmenopausal women younger than 65 years with 1 or more risk factors for osteoporosis: The USPSTF recommends screening for osteoporosis to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk for an osteoporotic fracture as estimated by clinical risk assessment. […] The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men. […] To achieve the benefit of screening to reduce morbidity and mortality from fractures, women found to have osteoporosis should be further evaluated, counseled, and, if appropriate, prescribed evidence-based management.

• #54 Diagnosis and Management of Osteoporosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0815/p261.html

  The U.S. Preventive Services Task Force (USPSTF) recommends screening all women 65 years and older. DEXA of the hip and lumbar spine is the preferred assessment method. The USPSTF also advises screening women younger than 65 years whose 10-year fracture risk is greater than or equal to that of a 65-year-old white woman without additional risk factors. […] The USPSTF found insufficient evidence to recommend routine screening for osteoporosis in men. Men with a minimal trauma fracture who are older than 50 years or those with secondary causes associated with bone loss could be considered for screening. The National Osteoporosis Foundation also recommends screening all men 70 years and older, based on the assumption that this group has a similar osteoporotic fracture risk and treatment effectiveness as 65-year-old white women.

• #55 Recommendation: Osteoporosis to Prevent Fractures: Screening | United States Preventive Services Taskforce

  https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosis-screening

  Women 65 years or older: The USPSTF recommends screening for osteoporosis to prevent osteoporotic fractures in women 65 years or older. […] Postmenopausal women younger than 65 years with 1 or more risk factors for osteoporosis: The USPSTF recommends screening for osteoporosis to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk for an osteoporotic fracture as estimated by clinical risk assessment. […] The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men. […] To achieve the benefit of screening to reduce morbidity and mortality from fractures, women found to have osteoporosis should be further evaluated, counseled, and, if appropriate, prescribed evidence-based management.

• #56 Recommendation: Osteoporosis to Prevent Fractures: Screening | United States Preventive Services Taskforce

  https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosis-screening

  Women 65 years or older: The USPSTF recommends screening for osteoporosis to prevent osteoporotic fractures in women 65 years or older. […] Postmenopausal women younger than 65 years with 1 or more risk factors for osteoporosis: The USPSTF recommends screening for osteoporosis to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk for an osteoporotic fracture as estimated by clinical risk assessment. […] The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men. […] To achieve the benefit of screening to reduce morbidity and mortality from fractures, women found to have osteoporosis should be further evaluated, counseled, and, if appropriate, prescribed evidence-based management.

• #57 Diagnosis and Management of Osteoporosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0815/p261.html

  The U.S. Preventive Services Task Force (USPSTF) recommends screening all women 65 years and older. DEXA of the hip and lumbar spine is the preferred assessment method. The USPSTF also advises screening women younger than 65 years whose 10-year fracture risk is greater than or equal to that of a 65-year-old white woman without additional risk factors. […] The USPSTF found insufficient evidence to recommend routine screening for osteoporosis in men. Men with a minimal trauma fracture who are older than 50 years or those with secondary causes associated with bone loss could be considered for screening. The National Osteoporosis Foundation also recommends screening all men 70 years and older, based on the assumption that this group has a similar osteoporotic fracture risk and treatment effectiveness as 65-year-old white women.

• #58 Diagnosis and Management of Osteoporosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0815/p261.html

  Osteoporosis is diagnosed radiographically based on bone mineral density (BMD) determinations from dual energy x-ray absorptiometry (DEXA) assessment. Although quantitative calcaneal ultrasonography and peripheral DEXA can also predict fracture risk, these modalities do not correlate well enough with central DEXA to be used diagnostically. The World Health Organization (WHO) established commonly accepted definitions of osteoporosis and osteopenia. The WHO criteria should not be applied to men younger than 50 years, children, or premenopausal women. For these groups, the International Society for Clinical Densitometry recommends use of the z score (age and sex norms). Z scores of 2.0 or less are below the expected range for age. Osteoporosis in men younger than 50 years cannot be diagnosed based on BMD assessment alone.

• #59 Diagnosis and Management of Osteoporosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0815/p261.html

  Osteoporosis is diagnosed radiographically based on bone mineral density (BMD) determinations from dual energy x-ray absorptiometry (DEXA) assessment. Although quantitative calcaneal ultrasonography and peripheral DEXA can also predict fracture risk, these modalities do not correlate well enough with central DEXA to be used diagnostically. The World Health Organization (WHO) established commonly accepted definitions of osteoporosis and osteopenia. The WHO criteria should not be applied to men younger than 50 years, children, or premenopausal women. For these groups, the International Society for Clinical Densitometry recommends use of the z score (age and sex norms). Z scores of 2.0 or less are below the expected range for age. Osteoporosis in men younger than 50 years cannot be diagnosed based on BMD assessment alone.

• #60 The pathogenesis, diagnosis, investigation and management of osteoporosis | Journal of Clinical Pathology

  https://jcp.bmj.com/content/64/12/1042

  The International Society for Clinical Densitometry recommend using the Z-score instead of BMD to be measured in premenopausal women and men younger than 50 years of age, with a score less than or equal to 2.0 indicative of a bone density that is below the expected range for age. […] The FRAX tool is particularly useful in identification of patients with osteopenia who are at higher risk of fracture. Though the FRAX algorithm is useful in assessing an individual’s absolute fracture risk and hence individualising treatment, it has some limitations which prevent it from being the gold standard. First, it has been designed for postmenopausal women and men older than 40 years of age who have not previously been on bone protective treatment. Second, it does not take into account dose-responses for several risk factors including glucocorticoid use. Third, falls or increased propensity to falls is not included in the algorithm. Fourth, femoral neck BMD only is used to compute fracture risk; therefore, absolute fracture risk may not be accurate in those patients who have lowest BMD at the spine. In addition, it is country-specific and has to be used cautiously in countries where there is no representation.

• #61 Diagnosis and Management of Osteoporosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0815/p261.html

  Osteoporosis is diagnosed radiographically based on bone mineral density (BMD) determinations from dual energy x-ray absorptiometry (DEXA) assessment. Although quantitative calcaneal ultrasonography and peripheral DEXA can also predict fracture risk, these modalities do not correlate well enough with central DEXA to be used diagnostically. The World Health Organization (WHO) established commonly accepted definitions of osteoporosis and osteopenia. The WHO criteria should not be applied to men younger than 50 years, children, or premenopausal women. For these groups, the International Society for Clinical Densitometry recommends use of the z score (age and sex norms). Z scores of 2.0 or less are below the expected range for age. Osteoporosis in men younger than 50 years cannot be diagnosed based on BMD assessment alone.

• #62 Self-Assessment Questions – Course #99144: Osteoporosis: Diagnosis and Management – NetCE

  https://www.netce.com/studypoints.php?courseid=2930&printable=yes&page=printquestions

  The diagnosis of osteoporosis in these groups should not be made based on densitometric criteria alone; the International Society for Clinical Densitometry (ISCD) has recommended instead that ethnicity- or race-adjusted Z-scores be used. […] Routine BMD screening has been recommended for women 65 years of age and older, regardless of risk, and for women 50 to 69 years of age with clinical risk factors for fracture. […] Given the multitude of tests, there are some general factors to keep in mind when ordering them. […] Serial measurements may be helpful to assess bone loss rates; however, they should not be performed too often. Follow-up measurements, one to two years apart, may be useful in determining whether patients with normal baseline bone mass demonstrate a rapid loss of BMD. […] The ability of quantitative CT to enable prediction of spinal fracture is equal to that of DXA scanning in postmenopausal women; there is lack of sufficient evidence for fracture prediction in men.

• #63 Osteoporosis Diagnosis – Bone Density Test | Health & Bone

  https://healthandbone.ca/en/osteporosis-diagnosis/

  Early osteoporosis diagnosis is important and can help prevent fractures from occurring in the first place. Osteoporosis Canada recommends combining bone mineral density (BMD) testing with a clinical risk assessment to accurately determine fracture risk. […] In Canada, it is recommended that a clinical risk assessment is performed in post-menopausal women and men 50 years of age. […] Less than 20% of patients with a fracture in Canada currently undergo diagnosis or adequate treatment for osteoporosis. […] Physicians can diagnose osteoporosis using two different clinical risk assessment tools: the fracture risk assessment tool (FRAX) or the Canadian Association of Radiologists and Osteoporosis Canada (CAROC) assessment tool. […] The go-to test recommended by Osteoporosis Canada is FRAX because it considers additional risk factors, like parental hip fracture, BMI, and alcohol intake.

• #64 The pathogenesis, diagnosis, investigation and management of osteoporosis | Journal of Clinical Pathology

  https://jcp.bmj.com/content/64/12/1042

  Osteoporosis is a systemic skeletal disorder which results from an imbalance in bone remodeling, leading to a reduction in bone strength, with microarchitectural disruption and skeletal fragility, increasing fracture susceptibility. Diagnosis of osteoporosis is based on measurement of bone mineral density (BMD), using dual X-ray absorptiometry (DXA), which is considered the gold standard. A personal history of fragility fracture is consistent with a clinical diagnosis of osteoporosis, regardless of BMD, in the absence of other causes of skeletal fragility. The WHO has defined osteoporosis as a T-score of less or equal to 2.5 and osteopenia as a T-score between 1.0 and 2.5. The T-score criteria are used for postmenopausal women and men aged 50 years or older. Outside this demographic group, the T-score is less accurate as a predictive tool for fracture risk. A major problem of osteoporosis management is that majority of those at high fracture risk are not diagnosed or treated, despite availability of safe and effective diagnostic tools and therapies.

• #65 Diagnosis, Screening and Treatment of Osteoporosis – A Review – Biomedical and Pharmacology Journal

  https://biomedpharmajournal.org/vol14no2/diagnosis-screening-and-treatment-of-osteoporosis-a-review/

  Apart from the above test DEXA (Dual X-ray Absorptiometry) scan is used for the measurement of bone mineral density. DEXA scan has been the golden standard method for the diagnosis of osteoporosis. […] Older adults who are considered to be at higher risk of Osteoporosis must be screened periodically. They must be evaluated for fracture risk also. […] The medical history obtained must completely focus on the risk of having low bone mineral density and the risk of falls. […] The presence of gait disorder, weakness, and postural instability are considered as factors that increase the risk of fractures and falls. […] Osteoporosis is becoming a life-threatening health issue in recent times due to its increase in fracture risk. The main problem is it is often under recognized and untreated which leads to an increase in fracture risk. Patients at a high risk of fractures dont get enough evaluation for the disease or get proper treatment. […] There is not much data on the proper screening techniques available for the treatment of Osteoporosis. The role of risk factor assessment, different bone density techniques, the frequency of screening, and the groups to whom the treatment can be made effective remains unclear.

• #66 Osteoporosis Diagnosis – More Than Quantitative Testing – BeamMed Inc.

  https://www.beammed.com/osteoporosis-diagnosis/

  Early diagnosis of osteoporosis is vital to helping people maintain good bone strength and avoid debilitating fractures as they age. […] Osteoporosis diagnosis is thought by some to rest on the results of various technology-driven osteoporosis tests, such as bone mineral density tests. […] However, rather than technology, it is physicians who determine osteoporosis diagnosis. […] Physicians evaluation of clinical risk factors, lifestyle habits and other issues should be combined with quantitative measurement in order to ensure accurate diagnosis of osteoporosis, and long-term monitoring of the disease. […] While osteoporosis cannot be reversed, it can be effectively managed by early diagnosis of bone mass loss and by prevention of further loss. […] Diagnosis of osteoporosis at the early stages can improve peoples quality of life and bring down direct and indirect costs.

• #67 Clinical manifestations, diagnosis, and evaluation of osteoporosis in postmenopausal women – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-evaluation-of-osteoporosis-in-postmenopausal-women

  Clinical manifestations, diagnosis, and evaluation of osteoporosis in postmenopausal women […] Osteoporosis is characterized by low bone mass, microarchitectural disruption, and skeletal fragility, resulting in decreased bone strength and an increased risk of fracture. […] The World Health Organization (WHO) has defined diagnostic thresholds for low bone mass and osteoporosis based upon BMD measurements compared with a young adult reference population (T-score). […] Early diagnosis and quantification of bone loss and fracture risk are important because of the availability of therapies that can slow or even reverse the progression of osteoporosis. […] The clinical manifestations, diagnosis, and evaluation of osteoporosis in postmenopausal women will be reviewed here. […] Osteoporosis has no clinical manifestations until there is a fracture.

• #68 Osteoporosis Diagnosis – More Than Quantitative Testing – BeamMed Inc.

  https://www.beammed.com/osteoporosis-diagnosis/

  Early diagnosis of osteoporosis is vital to helping people maintain good bone strength and avoid debilitating fractures as they age. […] Osteoporosis diagnosis is thought by some to rest on the results of various technology-driven osteoporosis tests, such as bone mineral density tests. […] However, rather than technology, it is physicians who determine osteoporosis diagnosis. […] Physicians evaluation of clinical risk factors, lifestyle habits and other issues should be combined with quantitative measurement in order to ensure accurate diagnosis of osteoporosis, and long-term monitoring of the disease. […] While osteoporosis cannot be reversed, it can be effectively managed by early diagnosis of bone mass loss and by prevention of further loss. […] Diagnosis of osteoporosis at the early stages can improve peoples quality of life and bring down direct and indirect costs.

• #69 Importance of Early Diagnosis and Treatment of Osteoporosis to Prevent Fractures

  https://www.ajmc.com/view/may06-2313ps181-s190

  Osteoporosis affects about 10 million individuals in the United States, a number that is expected to increase substantially in coming decades as the elderly population burgeons. […] This manuscript reviews the pathophysiology of osteoporosis, examines issues related to the diagnosis of osteoporosis, especially the role of bone mineral density measurement, and focuses on the impact of various treatment options in reducing fracture risk. Early assessment and treatment emerge as medically prudent steps in reducing the risk for osteoporosis-related fracture. […] The clinical evaluation of the skeletal system includes a medical history, physical examination, laboratory testing, and, if appropriate, BMD testing. […] The presence of 1 or more risk factorsolder age, previous fracture, low body weight, smoker, menopause, low BMD, family history of osteoporosis, hypogonadism in males, exposure to glucocorticoidsincrease the risk of osteoporosis.

• #70 Making a Diagnosis for Osteoporosis

  https://www.bonehealthandosteoporosis.org/patients/diagnosis-information/

  People can have osteoporosis without any signs or symptoms. When you have osteoporosis, your bones become weak and are more likely to break. Because it is a disease that can be prevented and treated, an early diagnosis can make a difference. […] You can find out whether you have osteoporosis or if you should be concerned about your bones by getting a bone mineral density (BMD) test. A BMD test uses a special machine to measure bone density. […] If you are diagnosed with osteoporosis, your healthcare provider may order laboratory and other tests. These tests can help your healthcare provider find out if you have another medical condition causing bone loss. […] A medical evaluation to diagnose osteoporosis and estimate your risk of breaking a bone may involve one or more of the following steps: Clinical Exams, Medical history, Physical examination, Laboratory tests, Bone density test, FRAX® score. […] Other tests that may be used to evaluate bone health but are not used to diagnose osteoporosis include biochemical marker tests, x-rays, vertebral fracture assessments (VFAs), and bone scans.

• #71 Osteoporosis: diagnosis and risk assessment – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/osteoporosis-diagnosis-and-risk-assessment

  Osteoporosis: diagnosis and risk assessment. How bone structure and function is affected by osteoporosis and how to accurately the risk of fracture as part of formal diagnosis. Osteoporosis causes almost nine million fractures worldwide annually, with over 300,000 patients presenting to UK hospitals with fragility fractures each year. Fragility fractures are associated with a significant risk of mortality and morbidity and are an enormous economic burden to healthcare —with the majority of costs relating to hip fracture care. Direct medical costs from fragility fractures to the UK healthcare economy were estimated at £1.8bn in 2000, and could potentially increase to £2.2bn by 2025. Hip fracture incidence in the UK is predicted to rise from 70,000 per year in 2006 to 91,500 in 2015, and further still to 101,000 in 2020. The admission rate for hip fractures has increased in England by 2.1% per year since 1999, while hospital bed days have increased by 5.9% per year. An ageing population means that the number of osteoporotic fractures is predicted to double over the next 50 years if changes are not made to current practice. Osteoporosis can be diagnosed and treated before a fracture occurs. More importantly, even after the first fracture has occurred, there are effective treatments to decrease the risk of future fractures. It is important to exclude secondary causes of osteoporosis by carrying out investigations including calcium and phosphate levels, liver function tests, thyroid function tests and in selected patients vitamin D and parathyroid hormone levels. The assessment of fracture risk is crucial in determining which patients to treat. Bone mineral density (BMD) combined with the assessment of clinical risk factors for fracture is a better predictor than BMD or clinical risk factors alone. The predictive value of BMD for hip fracture is at least as that of blood pressure for stroke. BMD testing allows a physician to diagnose osteoporosis in high risk patients before a fracture occurs and offer interventions to reduce fracture risk. The International Osteoporosis Foundation and WHO recommends that the reference technology for the diagnosis of osteoporosis is dual energy X-ray absorptiometry (DXA). DXA is a technique that uses extremely low doses of ionising radiation to quantify BMD as a T-score accurately and precisely. Osteoporosis is a consequence of an imbalance in the process of bone remodelling. This results in a significant increase in the risk of fragility fractures which are associated with high mortality and morbidity as well an increasing financial burden on the National Health Service. Risk assessment is pivotal to identify individuals who are at high risk of fractures and in whom preventative treatment will provide benefit.

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