Diagnosing and Treating Osteoporosis
People with osteoporosis don’t experience symptoms until they have a fracture and they may not know they have the disease until they break a bone or they have a bone density test.
Dual energy X-ray absorptiometry (DXA) is the technique most commonly used for measuring bone mineral density. Two X-ray beams with different energy levels are use to estimate the patient’s bone density. The radiation exposure is extremely low.
DXA testing is recommended for:
- Women over age 65
- Postmenopausal women under age 65 with additional risk factors for osteoporosis
- Patients with fragility fractures (fractures occurring without much trauma)
- Patients with diseases associated with osteoporosis or on medications associated with osteoporosis
- Men over age 70
- Patients on osteoporosis treatment (to monitor response)
In addition to DXA, patients typically undergo a laboratory evaluation (blood and urine) to check for problems that may cause bone loss. About one-third of postmenopausal women with osteoporosis have an underlying problem contributing to bone loss, such as vitamin D deficiency or an intestinal disorder that affects the absorption of nutrients.
Vertebral fracture assessment (VFA) is done for selected patients along with the DXA test. This consists of evaluating DXA images of the spine to identify compression fractures of the vertebrae. When combined with the bone mineral density test, VFA helps determine the person's risk of future fracture.
Treatment for osteoporosis is designed to prevent further bone loss and/or increase bone density and decrease fracture risk. Treatment is based on the unique needs of each patient and may include:
- Calcium and vitamin D supplements
- Prescription medications to prevent bone loss or to increase bone density
- Physical therapy to strengthen back muscles and help prevent falls
- Weight-bearing exercise
- Lifestyle changes such as quitting smoking decreasing alcohol use
Occasionally, when patients have persistent pain after a vertebral compression fracture, vertebroplasty or kyphoplasty may be done. These are both minimally invasive procedures. In vertebroplasty, a physician uses image guidance to inject a special “cement’ mixture through a needle into the fractured vertebrae. In kyphoplasty, a balloon is first inserted through the needle into the fractured vertebrae in an attempt to restore the height of the bone. The balloon is then removed and cement is injected into the space created by the balloon.
During treatment of osteoporosis, patient response to therapy is monitored clinically and through bone density testing.