If you are worried about developing osteoporosis – or even suspect that you already have it long before the condition might be verified by a fracture – there are tests, examinations and assessments that could either allay or confirm your suspicions.

In fact, there are several ways to go about dealing with diagnosing osteoporosis, or even beginning some preventative treatments. Osteoporosis is a common disease that is characterised by low bone mass with skeletal fragility, resulting in an increased risk of fracture. It is known as the ‘silent disease’ because you may have no idea you suffer from bone weakening until you break something – usually a wrist or a hip.

Bone Density Test

If you suspect osteoporosis, your doctor will most likely order a bone density scan. This exam is used to measure bone mineral density (BMD). It is most commonly performed using dual-energy X-ray absorptiometry (DXA or DEXA) or bone densitometry. To help determine your risk for the condition, doctors may also make use of the Fracture Risk Assessment Tool (FRAX). Your FRAX score is your risk of having an osteoporosis-related fracture in the next 10 years – and the measurement formula for risk factors includes: age; weight; gender; smoking history; alcohol; fracture history.

The initial osteoporosis evaluation includes:

  • a history to assess clinical risk factors for fracture
  • a test for other conditions that may also contribute to bone loss – including a physical examination, and basic laboratory tests. There are many co-existing medical conditions that can contribute to bone loss.
  • evaluation for alternative causes of bone loss and to detect potentially reversible causes because osteoporosis can occur in people who have few or no risk factors for this condition. Screening at-risk populations is, therefore, essential.

Clinical Exams

Medical History
Factors investigated will include:

  • Whether you have had regular periods (pre-menopausal women)
  • Whether you have reached menopause (women)
  • Your personal history of broken bones as an adult
  • Your family history of broken bones and osteoporosis
  • Your smoking or drinking habits
  • Your diet, including how much calcium and Vitamin D you get
  • Your exercise and physical activity
  • Whether you have had an eating disorder such as anorexia nervosa
  • Your testosterone levels (men)
  • Whether you take any medicines or have any medical conditions that may cause bone loss.

Physical Examination
Decreased bone strength is related to many factors other than bone mineral density, including rates of bone formation and resorption, bone geometry (size and shape of bone), and microarchitecture. During osteoporosis physical exam testing, your healthcare provider may measure you to see if you have lost height and examine your spine. After age 50, you should have your height checked without shoes every year at the same healthcare facility.

Laboratory Tests

Blood and urine tests can be used to identify possible causes of bone loss. Some of these tests include:

  • Blood calcium levels
  • 24-hour urine calcium measurement
  • Thyroid function tests
  • Parathyroid hormone levels
  • Testosterone levels in men
  • 25-hydroxyvitamin D test to determine whether the body has enough vitamin D
  • Biochemical marker tests, such as NTX and CTX.

Other Tests to Evaluate Bone Health
Biochemical marker tests of the blood and/or urine may help to estimate how fast you’re losing or making bone. X-Rays and Vertebral Fracture Assessments (VFAs) can show breaks in the spine. Nuclear bone scans, CT Scans or MRIs can show changes that may be caused by cancer, bone lesions, inflammation, new broken bones, or other conditions. They are often used to help find the cause of back pain or to follow up on abnormalities seen on an X-ray.

Bone biomarkers, including formation and resorption, are released during the bone remodelling processes. Combined with the measurement of bone mineral density, the clinical applications of bone biomarkers have provided comprehensive information for diagnosis of osteoporosis.

Early diagnosis and quantification of bone loss and fracture risk have become more important because of the availability of therapies that can slow or even reverse the progression of osteoporosis.

Love your bones! However you decide to get tested – get tested regularly!

NOFSA (National Osteoporosis Foundation South Africa)

NOFSA is the only non-profit, voluntary health organisation dedicated to promoting lifelong bone health. We focus on reducing the widespread prevalence of osteoporosis while working to find a cure for the disease, and by supporting research and developing programmes of education and advocacy.

Find out more about our work at: www.osteoporosis.org.za