Osteoporosis is the most common metabolic bone disease in existence. The fractures seen with osteoporosis produce significant health issues and the economic burden to the health care system is incredibly high. The cornerstone of evaluation for osteoporosis is bone mineral density (BMD). It correlates well with fracture risk and allows doctors to not only determine if medication treatment is necessary but also the response to that treatment.
Initial methods of determining bone mineral density relied on standard x-rays and looking at trabecular bone patterns with grading. This turned out not to work well at all. This was in the 1950's timeframe and by the 1960's, single photon absorptiometry came into existence. Eventually this turned into dual photon absorptiometry, which was very good at differentiating bone from soft tissue.
The standard of care that has been developed for BMD is dual energy x-ray absorptiometry (DXA). This technology differentiates between bone from soft tissue by evaluating photon beams that are transmitted through two different energy levels. As the beams travel through the various tissues, they become weakened differently.
A DXA measures bone mineral density along with area. The BMD is divided by the area, and that is converted to a T score. Performing serial testing allows one to determine BMD changes over time.
The World Health organization defines bone mineral densities according to this T score. A normal T score is equivalent to that of a "young normal" which is within one standard deviation of normal. If one's T score is between 1 and 2.5 standard deviations lower than these normal, the World Health Organization defines it as osteopenia. Anything above 2.5 standard deviations falls into the category of osteoporosis.
The National Osteoporosis Foundation suggests that one should inititate medication treatment for those with a T score below 2.0. They have also published major risk factors in their treatment guidelines which include: Personal history of fracture, Family history of fracture, Current cigarette smoker, and weight less than 127 pounds.
They have also recommended the various groups that should be tested with DXA. They include: All women over age 65, Postmenopausal women with major risk factors, All people over age 50 who suffer an osteoporotic fracture and anyone taking long term corticosteroids. With regards to men, anyone over age 70 or experiencing a hypogonadal condition should be tested.
Depending on the T scores resulting from the repetitive DXA scans, treatment decisions can be adjusted consisting of anti-resorptive agents along with weight bearing exercise.
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