Osteoporosis is a disease that causes bones to weaken over time and become more prone to fractures, which can lead to complications. Approximately 10 million people over the age of 50 in the United States have osteoporosis. This is especially true after menopause, when the body's production of the hormone estrogen, which helps maintain bone density, decreases. During this period, it is important to perform osteoporosis screening to diagnose osteoporosis early.
Your bones continue to grow and become denser until you are about 25 years old. After that, the bone remains roughly the same, with the same amount of destruction and new growth occurring. However, after age 50, there is more bone destruction than new growth.
Osteoporosis usually has no obvious symptoms, but the first sign may be bones becoming weaker and then breaking. Osteoporosis is a common cause of fractures in older adults, so regular screenings to check bone density are essential to treating osteoporosis and preventing fractures.
Sarah Musleh, MD, a Dallas-based endocrinologist and co-founder of Anzara Health, says that for people who have experienced menopause and no other risk factors or history of bone fractures, screening guidelines do not It states that it is recommended to begin screening for osteoporosis through measurement tests. Musleh also points out that low testosterone levels and chronic kidney disease (conditions that can lead to decreased bone density in men) may also be reasons for a bone measurement test.
The first step in receiving a diagnosis is a physical exam, during which your health care provider will ask questions about your health history. Questions include:
- Have you had a stress fracture before?
- Has anyone in your family been diagnosed with osteoporosis or broken a hip in a fall?
- do you smoke?
- How often do you drink alcohol?
- What does your typical meal look like?
- Does it have enough calcium and vitamin D?
- How often do you exercise or do physical activity?
- What medicines are you taking?
These questions will help you understand your risk factors for developing the condition. For example, Dr. Musleh says smoking cigarettes or consuming large amounts of alcohol increases your risk of losing bone density.
Kevin R. Stone, M.D., an orthopedic surgeon at the Stone Clinic in San Francisco, says one of the things health care professionals often check for when it comes to bone disease is whether bone pain is present. If there is pain, the physical exam may include checking to see if there is impact pain and whether it is consistent with a stress fracture, Dr. Stone says. These clues can be gathered through testing at your provider's office.
“If I could jump on one leg, [does] “Most stress fractures are pretty much ruled out because they don't cause sudden pain,” says Dr. Stone. “If you have a mild stress fracture in your hip, shin, or foot, [once] They jump on one leg, usually reproducing the pain. ”
Once your health care provider has enough information from the test, they may recommend screening tests or laboratories to check your bone density, nutrient and hormone levels, and anything else that might help you get a complete picture of your bone health. More likely to order.
Bone density tests measure bone density and strength and can be used to diagnose osteoporosis. The most frequently used diagnostic test is dual-energy X-ray absorptiometry (DEXA or DXA).
A DEXA scan is a test that uses low-dose X-rays to show bone density in the hip, spine, or wrist. This test is the gold standard for diagnosing osteoporosis, and if the scan is abnormal, it's an indicator of bone deficiency, Dr. Stone says.
DEXA results are provided through a scoring system called the T-score, where the results are compared to the bone density of healthy young adults. T-score levels include:
- usually: T-score between +1 and -1
- Low bone mass: T-score between -1 and -2.5
- osteoporosis: T-score is -2.5 or less
- Severe osteoporosis: T-score ≤ -2.5 and one or more fractures
Other tests can check bone health, but they are not used as often as DEXA. These tests include:
- Quantitative computed tomography (QCT): It uses higher radiation levels than DEXA to three-dimensionally measure the bone density of the hip and spine, and measures the bone density of only the cancellous bone inside the vertebrae.
- Biomechanical computed tomography (BCT): It takes information from a CT scan of the hip or lower spine and uses it to measure bone density.
- Radiofrequency ultrasound multispectrometry (REMS): Ultrasound test to measure bone density in the lower back and spine.
- Examination at peripheral (other than spine, other than hip joint) sites: A test used to measure bone density in areas other than the hip and spine, such as the arms, legs, fingers, wrists, and heels. Examples of these include pDEXA (peripheral dual-energy X-ray absorptiometry), pQCT (peripheral quantitative computed tomography), and QUS (quantitative ultrasound).
Dr Musleh says extensive clinical testing is done to determine a person's bone health. This means more than just checking your vitamin D and calcium levels. Musleh said the blood tests will also check kidney function, parathyroid hormone levels, thyroid hormone levels, liver function and blood cell counts. These measurements can be used to understand how the amount of calcium in the blood and the function of glands and organs contribute to osteoporosis.
According to Dr. Stone, elevated levels of calcium in the blood indicate hyperparathyroidism, and decreased calcium levels indicate malabsorption (difficulty absorbing nutrients from food) or vitamin D deficiency.
Hyperparathyroidism occurs when the parathyroid glands produce large amounts of parathyroid hormone, which regulates blood flow and calcium balance in tissues. If this balance is not maintained and there is too much calcium in the bloodstream and not enough in the bones, it can lead to osteoporosis.
Another test used to assess bone health is the 24-hour urinary calcium excretion test, which measures the amount of calcium in the urine, according to Dr. Stone.
As people get older, their risk of fractures tends to increase. Studies have shown that people over the age of 65 are three to four times more likely to die within a year after surgery for a femoral neck fracture than younger people.
Dr Musleh says recovery after a hip fracture can be difficult for people over 70. She explains that older people who undergo hip fracture surgery are at risk for urinary tract infections (UTIs) and blood clots during their hospital stay, which can lead to pulmonary embolism and stroke. Therefore, it is important to diagnose and treat osteoporosis in your 50s and early 60s to strengthen your bones, maintain bone density, and prevent fractures.
Depending on test results, treatment may include preventing further loss of bone density or rebuilding bone to replace severe bone loss.
Calcium and vitamin D supplements may be helpful, but medication is often essential for treatment. “If you have osteoporosis and need treatment, calcium and vitamin D are additives to your medication,” says Dr. Musleh.
Dr. Stone also recommends resistance exercise as an important part of treatment because bones respond to stress. Resistance exercise, such as climbing stairs, hiking, and weight lifting, can slow bone loss that begins after age 30.
The goal is to reduce the risk of fractures. “If your bones are as strong as we have available, you can fall and get a bruise, but you won't end up with a fracture,” Dr. Mousle says.
When looking for a medical provider to diagnose and treat osteoporosis, she recommends looking for either a primary care physician who specializes in bone health or an endocrinologist who treats people with low bone density. Osteoporosis is a chronic disease, so seeing the right doctor increases your chances of getting the right treatment and understanding the process, Dr. Mousle says.
“If you have received treatment and are now off treatment, we strongly recommend that you have another bone density test in a few years to ensure that your bone is still retained and has good density.” Advocate,” she says.
Osteoporosis is a disease that weakens bones and increases the risk of fractures, and affects millions of people, especially postmenopausal women and people over 50. Screening with bone measurements usually begins around age 65. Diagnosis is determined by physical examination and DEXA scan. Methods such as this can help inform your treatment plan. This may include medications, exercise, and supplements to prevent fractures.
With increasing age, the risk of fracture increases significantly, especially after proximal femoral fractures, leading to increased mortality in the elderly. Early diagnosis and treatment can prevent fractures and related complications. This may include regular monitoring of bone density every two to three years. Optimal care includes finding a health care provider who specializes in managing osteoporosis to track your progress and find the treatment that's right for you.
