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...currently is the most widely used. Routine screening of women aged 65 years and older generally is recommended. Bone density measurement may be used to determine diagnosis of osteoporosis, assess fracture risk, and help monitor patients who are receiving treatment. Use of the T-score evolved because the various bone density devices differ in their absolute measurements. The precision of bone density measurements is site-dependent. The physician who orders the test should review it to obtain several helpful pieces of information. (J Musculoskel Med. 2005;22:528-542)
Osteoporosis has had a significant impact on individual persons and society. Several large epidemiologic studies have shown that a fracture will develop in 40% to 50% of postmenopausal women during their lifetime.1 Each year, more than 1.5 million persons in the United States experience a fracture related to weakened bones-the so-called fragility fracture-that may lead to increased morbidity (eg, pain and disability) and hospitalization and reduced independence. Fragility fractures also result in an 18% reduction in survival, primarily during the first year after a hip fracture, and a similar reduction occurs over 5 years for patients identified as having symptomatic vertebral fractures.2 With appropriate treatment, however, fracture risk may be reduced by almost 50%.3
When many physicians attended medical school, they learned about treating patients who had established diseases. Now physicians, especially those practicing primary care medicine, spend a significant portion of their time attempting to prevent disease and keep their patients healthy. Osteoporosis is one area in which efforts have turned to prevention. In the process, the definition of osteoporosis has changed.
Until the latter part of the 1980s, the diagnosis of osteoporosis typically was made only after the occurrence of a fragility fracture.
Osteoporosis was defined as a general loss of bone mass to differentiate it from osteomalacia, in which mineralization of a normal volume of bone was lacking. In 1991, a consensus panel altered the definition to include the concept of low bone mass combined with microarchitectural deterioration of bone leading to the development of fractures.4 This revised definition has challenged professionals in the field to make a diagnosis in those persons who have low bone mass or microarchitectural deterioration or both to reduce bone fragility and the risk of fracturing.
Fracture predictions can be made on the basis of bone density testing in combination with other clinical risk factor assessment. The ability to predict fractures in a person and intervene before the event is a significant advance in the practice of clinical medicine. Several scientific bodies have agreed that bone density testing is indicated in all women aged 65 years and older. Agreement about testing in other population groups is less universal.
Bone density testing may be used to diagnose osteoporosis according to the World Health Organization (WHO) classification criteria, to determine fracture risk, and to help monitor patients who are receiving treatment or those being monitored for possible therapy. Clinicians should be able to interpret bone density testing results and to look at images for possible technical problems. Because the definition of osteoporosis has changed, practicing physicians now are responsible for identifying patients at risk for osteoporosis and attempting to prevent its appearance. In this article, I explain how that might be accomplished.
The diagnosis of osteoporosis
A diagnosis may be made based on a history of a previous fragility fracture or by identifying low bone mass (Figure 1). In postmenopausal women, a previous fracture confers a 1.5 to 4 times increased risk of subsequent fracture.5 Whether such a previous fracture is the result of limited trauma consistent with a fragility fracture...
NOTE: All illustrations and photos
have been removed from this article.
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