How is osteoporosis diagnosed?
The common clinical indicators used to diagnose osteoporosis are the occurrence of fragility fractures and/or low bone mineral density. Chen Dayong, Department of Orthopedics, Shanghai First People’s Hospital Branch
A fragility fracture is a clear indication of decreased bone strength and is the end result of osteoporosis and its comorbidities. The occurrence of a fragility fracture is clinically diagnostic of osteoporosis.
Bone densitometry is the best quantitative indicator to clinically diagnose osteoporosis, predict the risk of osteoporotic fractures, monitor the natural course of the disease and evaluate the efficacy of pharmacological interventions.
How is bone densitometry performed?
Bone density is the amount of bone per unit volume (bulk density) or per unit area (area density). There are many clinical methods of bone densitometry. The role of different methods in the diagnosis of osteoporosis, the monitoring of the efficacy and the assessment of the risk of fracture is different. Currently, the international academic community recognizes that the measurement of bone density of the hip by dual-energy X-ray absorptiometry (DXA) is the gold standard for the diagnosis of osteoporosis.
Other methods are of social and clinical significance as a census of osteoporosis and preliminary screening of the osteoporotic population. They cannot be used as the final diagnostic criteria.
How to read the Bone Densitometry value?
Bone density is usually expressed as T-Score (T-value).
T-Score = (measured value – peak bone) / standard deviation of bone mineral density in normal subjects.
It is normal for bone density to be less than 1 standard deviation below the peak bone density of a normal adult of the same sex and race. A decrease of between 1 and 2.5 standard deviations is considered low bone mass (decreased bone mass). A decrease equal to and greater than 2.5 standard deviations is considered osteoporosis.
When is bone densitometry necessary?
Bone densitometry should be performed in any of the following cases.
1.Women over 65 years old and men over 70 years old regardless of whether they have osteoporosis risk factors.
2.Women under 65 and men under 70 with one or more osteoporosis risk factors.
3. Men with a history of fragility fracture or/and a family history of fragility fracture. Female adults
4. Adults of both sexes with low levels of sex hormones from various causes.
5. Those who have osteoporotic changes on X-ray.
6.People who receive osteoporosis treatment and are monitored for efficacy.
7.History of diseases affecting bone metabolism or use of drugs affecting bone metabolism.
8, IOF osteoporosis one-minute test question answer result positive.
9, OSTA result ≤ 1.
10, Menopausal women.
11.People with low back pain or lower limb pain and no history of trauma.
12, Those with a history of obstetrical and gynecological disease or breast disease surgery.
What diseases should be distinguished from primary osteoporosis?
Osteoporosis can be caused by a variety of etiologies. When diagnosing primary osteoporosis, a number of diseases should be differentiated. For example, endocrine diseases that affect bone metabolism (gonadal, adrenal, thyroid and parathyroid diseases). Immune diseases such as rheumatoid arthritis, diseases of the digestive tract and kidneys that affect the absorption and regulation of calcium and vitamin D, malignant diseases such as multiple myeloma, long-term use of glucocorticoids or other drugs that affect bone metabolism, and various congenital and acquired abnormalities of bone metabolism.
What is the basic examination for osteoporosis?
For patients who have been diagnosed or suspected of having osteoporosis, at least the following tests should be done: skeletal radiographs. Laboratory tests: routine blood, urine, liver function, kidney function, blood calcium, phosphorus; alkaline phosphatase; serum protein electrophoresis.
In addition to the basic tests, what other tests are required?
For further differential diagnosis, the following tests may be performed as indicated: blood sedimentation, gonadotropins, 25OHD,1,25(OH)2D, parathyroid hormone, urinary calcium and phosphorus, thyroid function. Cortisol, blood gas analysis, blood and urine light chain, tumor markers, etc.
What are bone turnover biochemical markers?
Bone turnover biochemical markers are the metabolic (breakdown and synthesis) products of the bone tissue itself. They are referred to as bone markers. The levels of bone turnover markers in the blood circulation or urine vary to varying degrees in normal subjects at different ages and in various metabolic bone diseases, representing the dynamic status of the whole body skeleton. The measurement of these markers helps to determine the type of bone turnover, the rate of bone loss, fracture risk assessment, understanding of disease progression, selection of interventions, and efficacy monitoring.
What are the common clinical bone markers?
Bone formation markers.
Bone resorption markers.
Serum alkaline phosphatase (ALP).
Urinary calcium/creatinine ratio at 2 hours fasting.
Osteocalcin (OC).
Serum anti-tartrate acid phosphatase (TRACP).
Bone alkaline phosphatase (BLAP).
Serum type I collagen cross-linked C-terminal peptide (SCTX).
Type I procollagen C-terminus prepeptide (PICP).
Urinary pyridinoline (Pyr).
Type I procollagen N-terminal prepeptide (PINP).
Urinary deoxypyridinoline (D-Pyr).
Urinary type I collagen cross-linked C-terminal peptide (U-CTX).
Urinary type I collagen cross-linked N-terminal peptide (U-NTX).
The International Osteoporosis Foundation recommends PINP and SCTX as two biochemical markers of bone turnover with relatively good sensitivity.