Definition and Overview
An osteoporosis evaluation is an assessment of a person’s risk for osteoporosis and fractures. This is especially beneficial for elderly or post-menopausal women but is also advisable for anyone, particularly those who meet certain risk factors. The evaluation is a service offered by general physicians or orthopedists and involves a thorough physical examination. Its purpose is to detect osteoporosis early and help prevent risks and complications that may affect the patient’s quality of life later on.
Osteoporosis, a condition caused by the deterioration of bone tissue, is characterized by bone fragility and decreased bone mass, which makes the bones weaker, putting the patient at an increased risk of a fracture. It typically occurs due to the poor acquisition of bone mass in the adolescence phase and when a person undergoes accelerated bone loss during the aging process. A link between estrogen deficiency and osteoporosis has been found, making women more susceptible to the disease.
Who Should Undergo and Expected Results
An osteoporosis evaluation is beneficial for people who meet the following risk factors:
- Low weight
- Petite frame
- Advanced age (over 65 years old)
- Sedentary lifestyle or lack of physical exercise and activity
- Poor nutrition
- Eating disorders
- Low calcium levels
- High caffeine intake
- High alcohol consumption, affecting the osteoblast function of the bones
- Frequent cigarette smoking, causing reduced bone mass
- Extended drug use
Low mineral femoral neck bone density
- Weak quadriceps
- High body sway
- Low weight
As mentioned earlier, osteoporosis evaluation predicts the patient’s risk of suffering a fracture. During the physical exam, BMD Z-scores will be taken and the presence of abnormalities such as a dowager’s hump on the spinal curvature will be determined. If the results of the initial evaluation detect some abnormalities, more tests may follow to confirm the diagnosis.
There is an advantage when an osteoporosis case is detected early and its intensity is evaluated thoroughly as there are several available therapies that can slow down the progression of the disease. Some of these may even help completely treat the condition before it causes lasting damage, such as a debilitating fracture.
How Does the Procedure Work?
Since there is usually no physical manifestation of the condition until a fracture occurs, an osteoporosis evaluation may involve a wide range of tests, including:
- Analysis of medical history to assess the patient’s risk of fracture – Patients' past and present conditions as well as their use of medications are assessed.
- Physical examination – This includes an examination of common fracture sites such as the pelvic area, the forearm, vertebrae, femoral neck, and proximal humerus.
- X-rays – These are helpful in detecting existing fractures, regardless of whether they are causing symptoms or not, as well as height loss due to an increased abnormal spinal curvature.
- Blood chemistry test – This evaluates a person’s calcium and phosphorus levels, as well as assesses the condition of the liver and kidneys.
- 24-hour urine testing – This can detect a malabsorption of calcium or a calcium leakage due to a kidney issue.
- Blood count – This detects an underlying condition, such as anemia, that may explain the lack of nutrients in the body.
- Protein levels – This helps rule out multiple myeloma.
- Thyroid function – This checks a woman’s estrogen levels to detect a heightened risk for the disease.
- Bone density measurement
- Bone biopsy, if found necessary
- Nuclear bone scan
These tests may be conducted in a private clinic, a hospital laboratory, or an examination room. Specific procedures and tests will be determined based on the patient's medical history.
Possible Risks and Complications
The evaluation itself is guaranteed safe; all procedures involved are safe and do not pose any complications even to elderly patients. In fact, when done pro-actively, an osteoporosis evaluation can help in identifying and quantifying the risk factors for fracture. It can then help in risk management and in preparing the patient for prevention or treatment procedures.
- The National Osteoporosis Foundation (NOF) Clinician's Guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation, Washington, DC. 2013.