Osteoporosis: Risks and Diagnostic Steps

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Doctor with PatientUncontrollable RisksThe disease is often progressive and, although osteoporosis cannot be cured, it may be controlled or prevented. Understanding the risks can be an important key to prevention. Some of the 'uncontrollable' risks include:

Women are at higher risk than men because they have less bone mass, experience menopause, and live longer.

Asian and Caucasian women, especially small boned women, are at highest risk for osteoporosis. Black people, especially men, are at lower risk because their bone mass is greater.

Family History
If there is a family history (e.g. maternal) it is important to tell your physician. Some risks can be 'controlled' by the patient. These include poor diet, smoking, excessive alcoholic intake, and an inactive lifestyle. Certain medications and metabolic disorders contribute to osteoporosis such as Cushing's Syndrome, hyperthyroidism, and hyperparathyroidism. Also, there are gastrointestinal disorders that can inhibit the body's ability to properly absorb calcium. In some cases, the osteoporosis is termed idiopathic, which means the cause is unknown.

Diagnosis Steps

Physical Examination
A thorough physical examination reveals a lot about the health and general fitness of the patient. The exam includes a review of the patient's medical and family history. A family history of osteoporosis or other attributing medical disorders is noted. The physician also requires laboratory tests including complete blood count, urinalysis, and thyroid function.

Neurologic Evaluation
A neurologic evaluation assesses the patient's symptoms including pain, numbness, paresthesias (e.g. tingling), extremity sensation and motor function, muscle spasm, weakness, and bowel/bladder changes. Particular attention may be given to the lower extremities. Either a CT Scan or MRI study may be required if there is evidence of neurologic dysfunction.

Radiographs and Bone Density Tests
An x-ray is performed if fracture is suspected. However, routine x-rays do not always confirm a diagnosis of osteoporosis. Tests that reveal bone density are more accurate. DEXA (dual energy x-ray absorptiometry) is a radiographic test used to measure bone density in the spine, hip, and wrist.

Bone Mineral Density (BMD) can also be used to measure bone density in the spine, hip, and wrist. This procedure is painless and noninvasive. It may be used to confirm a diagnosis of osteoporosis. BMD also detects low bone density and the rate of bone loss. Low bone density is an indicator, or early warning, that osteoporosis exists. The rate of bone loss helps the physician measure treatment progress.

The physician compares the test findings to the patient's symptoms and formulates a treatment plan.

Updated on: 09/11/15
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Osteoporosis Treatment and Pain Management
Harry N. Herkowitz, MD
This article provides an overview of osteoporosis. It is a significant national health problem due in part to a lack of patient awareness. It is critical that patients understand what osteoporosis is and what their responsibility to their own body is. They should do impact exercise on a regular basis, avoid smoking and excessive alcohol. They should maintain a reasonable weight, begin taking calcium with vitamin D well before menopause begins, and get regular checkups especially if there is a history of osteoporosis in the family.
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