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    Osteoporosis and Osteopenia Diagnosis

    It is recommended by the National osteoporosis foundation that all women over the age of 65, younger women with risk factors and postmenoupausal women who have broken bones should have their bone mineral density (BMD) measured. This can be done by the following methods.

    1. The standard way of measuring the bone density of the hip is by the use of central dual energy x-ray absorptiomety. This procedure takes about ten minutes to perform and is of low radiation risk. Dual energy x-ray absorptiomety can also be used to measure the densities of bone at the wrist and spine in addition to that of the hip.
    2. Peripheral dual energy x-ray absorptiomety is usually used to measure forearm and digit bone density.
    3. A non x-ray way of measuring bone density is the use of ultrasound, this method is often used to measure bone density at the heels, patella and tibia. Although ultrasound is not as precise as x-ray absorptiomety it may still predict the incidence of future fractures.

    Bone density measurement diagnostic scores

    Once the Bone density has been measures then a patient can be diagnosed as having healthy bones, having osteopenia or osteoporosis through the use of diagnostic scores. The results from bone mineral density tests can be given in three ways

    1. Density: grams of hydroxyapatite per cm squared.
    2. T-Score: This compares a patients bone density with that of a young healthy adult of the same sex.
    1. This method is usually used to diagnose osteopenia or osteoporosis in postmenopausal women and men over the age of 50.
    3. Z-score: This compares a patients bone density with that of the average BMD of a similar person. A score of above -2 is considered to be normal, whereas a score of less than -2 is seen as having a decreased bone density.
    1. This method is usually used in men under 50 and women who have not gone through the menopause.

    The differences between a patients measured T or Z score and that of the controls are given as standard deviations. One standard deviation is approximately 10 to 20 % of the predictive bone density value.

    Bone mineral density and osteoporosis classification

    These Standard deviations can then be used to classify the person who has been tested. (measured at the hip):

    1. Normal: within one standard deviation: T-score is equal or more than -1
    2. Osteopenia: soft or weak bones: Between one and two point five standard deviations. T-score is -1 to -2.5
    3. Osteoporosis: More than 2.5 standard deviations. T-score is less than -2.5
    1. Severe osteoporosis: A person with a T-score of less than -2.5 who has a previous fracture

    It is seen from the above that there are many ways to test and score and diagnose osteoporosis, your doctor should know the method that is best for you.

    References
    Mayes (2007) Review of post menopausal osteoporosis pharmacology. Nutr. Clin. Prac. 22:3: 276 to 285
    National Osteoporosis Foundation (2003). Guide to Prevention and Treatment of Osteoporosis. 38.
    Raisz (2005). Clinical practice: screening for osteoporosis. Engl. J Med. 353:164 to171