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To diagnose osteoporosis, doctors ask patients about medical history, perform a physical exam and order certain laboratory tests to make sure there are no other bone problems. The doctor may then send the patient for a bone density measurement. An abnormally low bone density suggests that the patient has osteoporosis.
Bone density measurements are not for everyone. It would be impractical to screen the entire population for osteoporosis in this way. However, those at risk of osteoporosis may benefit from the test, particularly if they are able to take steps to prevent further loss of bone mass.
Risk factors for osteoporosis include:
- Being female.
- Increasing age.
- Having a petite body frame.
- Caucasian or Asian ancestry.
- Sedentary lifestyle.
- High caffeine intake.
- Never being pregnant.
- Lifelong low-calcium intake.
- Smoking.
- Excessive alcohol use.
- Long-term use of certain drugs.
- Being postmenopausal.
- Low body weight.
- Having kidney disease.
- Having an endocrine disease.
- Having impaired calcium absorption.
Osteoporosis screening
Women age 65 and older should be screened routinely for osteoporosis, according to recommendations from the U.S. Preventive Services Task Force (USPSTF). However, routine screening should start at age 60 for women at increased risk for osteoporotic fractures. According to the USPSTF, low body weight is the single best predictor of low bone mineral density.
If you think you are at increased risk for osteoporosis, see your doctor and ask about having your bone density measured. Bone density is measured through painless, noninvasive scanning techniques based on X-ray radiation. For the most part, these techniques only require you to be positioned properly and to hold still during the scan.
Specific methods are:
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Dual-energy X-ray absorptiometry (DEXA). This is the best and most common screening test. This simple but accurate scan can measure bone density in the spine, hip and wrist - the areas most likely to develop osteoporosis. The procedure exposes the patient to little radiation, takes little time, is inexpensive and is very precise. Because of its precision, DEXA is well-suited to making repeated measurements. Serial bone density measurements may be done to track bone loss over time to evaluate the effectiveness of treatment or as part of clinical trials for new potential treatment for osteoporosis.
The DEXA measurement at the hip bone (femoral neck) provides the best predictor of hip fractures. Quantitative CT is more sensitive but exposes patients to more radiation. Measurement with other instruments at peripheral sites varies greatly with the site, type of test, number of sites tested, brand of densitometer and the relevance of the reference range.
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Quantitative computed tomography (CT). For the most part, this procedure is used to measure bone density in the lower back. However, it also can be used to measure bone density in other parts of the body. The accuracy and scanning time depends on the exact type of CT scanner used and may vary for different medical centers.
Note: Quantitative CT exposes the patient to much higher levels of radiation than regular CT. For this reason, it should not be used for women of childbearing age. If a woman is pregnant, the radiation could harm the fetus, particularly if the woman is in the very early stage of her pregnancy. It should not be used for repeated measurements in the same patient.
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Ultrasound of the calcaneus. Some doctors perform ultrasounds of the calcaneus (foot) because it may help identify bone architecture and density.
This article was reviewed and updated June 2007.
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