Early Detection of Osteoporosis

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Early Detection of Osteoporosis

Osteoporosis patients often feel no pain whatsoever at the beginning of the disease. Back or knee pain may not occur until much later. A bone fracture after a seemingly harmless fall or without any recognisable cause can also be a sign of osteoporosis. If the disease has progressed, such fractures, for example a femoral neck fracture or fractures of the vertebral bodies, tend to occur more frequently.

Early detection to stop progression

The earlier osteoporosis (bone loss) is detected and treated, the better the progression can be stopped. Accordingly, if you think you have broken your bones without any apparent reason, you should seek medical attention early. Doctors call this a ‘spontaneous fracture’. People who belong to the risk groups for osteoporosis should routinely have their bones checked by a physician. The first point of contact is usually the primary care physician. The general practitioner often refers the patient to a specialist, for example an orthopaedist.

Who belongs to the osteoporosis risk groups?

1. Women and men aged 70 and over 2. People aged 50 and over with various risk factors for osteoporosis-related fractures, for example

  • Patients with vertebral body fractures after minor injuries
  • People who are underweight, experience weight loss or anorexia
  • Smokers
  • Alcoholics
  • ‘Couch potatoes’ and people with prolonged limited mobility
  • People who do not consume enough calcium in their diet
  • People with a family history of predisposition to bone fractures
  • People with an increased propensity to fall due to taking medication (e.g. high-dose cortisone, antispasmodics or antidepressants)
  • People with certain diseases such as hormonal and metabolic diseases (e.g. hyperthyroidism or diabetes mellitus, especially type 1 diabetes), with certain kidney or gastrointestinal diseases, with some chronic inflammatory rheumatic joint diseases (especially rheumatoid arthritis), with certain neurological/psychiatric diseases (e.g. epilepsy, Alzheimer’s, Parkinson’s or depression), or patients with cardiac insufficiency (heart failure)


How is osteoporosis diagnosed?

The process of diagnosing osteoporosis usually consists of several parts. Each part of the diagnosis helps the physician determine whether osteoporosis is present and what the best treatment option is. The examination is very time-consuming, but not every patient goes through all parts. 1. The doctor-patient-consultation
  • What does the patient’s medical history look like? Are there comparable diseases within the family?
  • Are there complaints or limitations in everyday life, such as difficulty climbing stairs or pain after long walks?
  • Were there any broken bones or falls in the past?
  • Is there an underlying disorder?
  • Does the patient take certain medications?


2. The physical examination

  • Height and weight
  • Testing physical fitness and mobility
  • Measuring strength in the limbs, especially in the legs, and balance through certain movement tests
  • FRAX: The Fracture Risk Assessment Tool evaluates the probability of the bone fracture risk within the next 10 years including different questions to identify circumstances that can favour osteoporosis



3. Measurement of bone density (osteodensitometry, dual-energy X-ray absorptiometry)

  • Low-dose X-rays to determine bone density at the lumbar spine, the entire femur and the femoral neck
  • Comparison of the measured values with the age-typical mean values; if the deviation is too high, bone loss is suspected
  • Classification according to World Health Organization (WHO) criteria: level 0 (osteopenia: osteoporosis precursor), level 1 (osteoporosis without fractures), level 2 (manifested osteoporosis with one to three vertebral fractures), or level 3 (advanced osteoporosis with multiple vertebral fractures)
  • Alternative method for bone density measurement: quantitative ultrasound measurement (QUS)


4. X-ray examinations

  • Facilitate detection of bone fractures, in particular vertebral body fractures
  • Reveal slowly progressing fractures (deformation of vertebrae)


5. Blood tests

  • Especially if osteoporosis is suspected as a result of other disorders
  • Blood count
  • Liver and kidney values
  • Calcium and phosphate levels


In case of abnormal bone density findings, possible bone fractures or signs of other disorders as a cause of complaint, further examinations are indicated, such as CT (computed tomography), MRI (magnetic resonance tomography/magnetic resonance imaging) and bone biopsy.

All examinations serve to determine the disorder as accurately as possible and to initiate targeted treatment.

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