When you or your family members are over the age of 55, you need to pay attention to whether or not you have osteoporosis when you usually have back and leg pain, general bone pain, and low back discomfort. Generally speaking the quality of bone is getting looser and more brittle as we get older. You need to go to the hospital to check the quality of the bone, whether there is osteoporosis, to what extent osteoporosis, whether you need to treat and intervene it by some methods, so that our bone quality will stay young forever. Xinghua, Department of Bone and Joint, Guangzhou First People’s Hospital
The current clinical diagnosis of osteoporosis by is using the following aspects of examination, extracted to the osteoporosis guidelines 2011 related content.
General indicators for the diagnosis of osteoporosis: fragility fractures and/or low bone density have occurred, and there is a lack of clinical means to directly measure bone strength.
1, fragility fracture: is the ultimate manifestation of bone strength decline, there has been a fragility fracture clinically can be diagnosed osteoporosis.
Bone mineral density (BMD) is the best quantitative indicator for diagnosing osteoporosis, predicting the risk of osteoporotic fracture, monitoring the natural course of the disease, and evaluating the efficacy of drug interventions. BMD reflects only about 70% of bone strength. The risk of fracture is associated with low BMD, and the risk of fracture is increased when accompanied by other risk factors.
(1) Bone density measurement methods: Dual-energy X-ray absorptiometry (DXA) is currently the internationally accepted method of bone density examination, and its measured value is used as the gold standard for the diagnosis of osteoporosis. Other bone density examination methods such as various single photon (SPA), single energy X-ray (SXA), quantitative computed tomography (QCT,) etc. can also be used for reference in the diagnosis of osteoporosis according to specific conditions.
(2) Diagnostic criteria: It is recommended to refer to the diagnostic criteria recommended by the World Health Organization (WHO). Based on DXA measurement: Bone density value less than 1 standard deviation below the peak bone value of healthy adults of the same sex and race is normal; a decrease of 1 to 2.5 standard deviations is low bone mass (bone loss); a decrease equal to and greater than 2.5 standard deviations is osteoporosis; a decrease in bone density in accordance with the diagnostic criteria for osteoporosis accompanied by one or more fractures is severe osteoporosis. Nowadays, it is also usually expressed by T-Score (T-value), that is, T-value ≥ -1.0 is normal, -2.5
(3) Clinical indications for bone densitometry.
①Females over 65 years of age and males over 70 years of age without other risk factors for osteoporosis;
②Females under 65 years of age and males under 70 years of age with one or more risk factors for osteoporosis;
③Adults of both genders with a history of fragility fracture or (and) a family history of fragility fracture;
④Adults of both sexes with low sex hormone levels due to various causes;
(⑤) Those who have osteoporotic changes on X-ray;
(6) Those who are being monitored for the efficacy of osteoporosis treatment;
⑦History of diseases and drugs that affect bone mineral metabolism (refer to the relevant section).
3.Other assessment (screening) methods of osteoporosis
(1) Quantitative ultrasonography (QUS): It also has a reference value for the diagnosis of osteoporosis, and there are no uniform diagnostic criteria. It has similar effect to DXA in predicting the risk of fracture, and is economical and convenient, more suitable for screening, especially for pregnant women and children. However, monitoring response to drug therapy is not yet a substitute for direct measurement of bone mass (bone mineral content) in the lumbar spine and hip.
(2) X-ray radiography: the morphological structure of bone tissue can be observed, which is a better method for qualitative and localized diagnosis of various fractures caused by osteoporosis, and also a method to differentiate osteoporosis from other diseases. Commonly used radiographic sites include vertebrae, hip, wrist, metacarpal, heel and tubular bones. Due to various technical factors, the sensitivity and accuracy of diagnosing osteoporosis by X-ray radiography is low, and only when the bone volume decreases by 30% can it be revealed in the X-ray, so it is not significant for early diagnosis. Since patients with osteoporosis often lack obvious symptoms, many people are only discovered during physical examinations or radiographs for other purposes, such as vertebral fractures. If back pain worsens and height shortens significantly, vertebral X-ray should be performed.
4.Laboratory tests
(1) Routine blood and urine tests, liver and kidney functions, blood glucose, calcium, phosphorus, alkaline phosphatase, sex hormones, 25(OH)D and parathyroid hormone can be selected according to the need of differential diagnosis.
(2) According to the needs of disease monitoring, drug selection and efficacy observation and differential diagnosis, the following indicators of bone metabolism and bone transformation (including bone formation and bone resorption indicators) can be selected respectively by the conditional units. These indicators are useful for the typing of bone turnover, assessment of bone loss rate and risk of fracture in elderly women, and selection and evaluation of disease progression and interventions. Common clinical indicators: serum calcium, phosphorus, 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D. Bone formation indicators: serum alkaline phosphatase (ALP), osteocalcin (OC), bone-derived alkaline phosphatase (BALP), type l procollagen C-terminal peptide (PICP), N-terminal peptide (PINP); bone resorption indicators: urinary calcium/creatinine ratio at 2 hours fasting, or plasma antitartaric acid acid phosphatase (TPACP) and l-type collagen C-terminal peptide (S-CTX), urinary pyridinoline (Pyr) and deoxypyridinoline (d-Pyr), urinary type I collagen C-terminal peptide (U-CTX) and N-terminal peptide (U-NTX), etc.