MedifocusHealth

Medical History

• Menstrual and menopause history
• History of back pain
• History of calcium intake (lifelong)
• Family history of osteoporosis
• Other medical conditions

Physical Examination

• General physical exam
• Height (annually)
• Mulculoskeletal exam
• Breast exam and mammogram (if estrogen therapy being considered)

Laboratory Evaluation

• Complete blood count (CBC)
• Serum chemistries including calcium, phosphorus, and alkaline phosphatase
• Thyroid function tests
• Erythrocyte sedimentation rate ("sed rate")
• 25-Hydroxyvitamin D level
• 24-hour urinary calcium and creatinine levels
• Serum and urinary protein electrophoresis (if appropriate)
• Testosterone level (men only)
• Urinary free cortisol and parathyroid hormone levels (if appropriate)
• Serum and urinary markers of bone turnover

Radiological Evaluation of Silent Fractures

The most common sites for osteoporotic fractures are the spinal column (vertebrae), the hip, and the forearm. Fractures that occur as a result of trauma, such as an accidental fall, are easy to recognize clinically, however, many people with osteoporosis develop "silent" or subclinical fractures that are not clinically apparent. In fact, about 65% of vertebral fractures are "silent" fractures that can only be detected by radiographic imaging. Imaging modalities that may be used to detect silent osteoporotic fractures include:

• Plain X-rays
• Computed tomography (CAT) scans
• Magnetic resonance imaging (MRI)
• Bone scans

Bone Mineral Density Evaluation

Standard imaging modalities (e.g., plain X-rays; CAT scans; MRI), while useful in diagnosis advances osteoporosis (e.g., silent fractures) are not useful for identifying people with early osteoporosis. Plain X-rays can only detect osteoporosis once the disease has advanced to the point where about 30% to 50% of the bone has been lost. Ultrasound methods of screening for osteoporosis are imprecise. Definitive diagnosis of osteoporosis requires the use of quantitative imaging studies to actually measure the bone mineral density.

The current "gold" standard for measuring bone mineral density is dual energy X-ray absorptiometry or "DEXA" for short. This technology involves scanning the lumbar spine, the hip, and the radius by transmitting a beam of X-rays through these areas and measuring the amount of X-ray absorption with an X-ray detector. Healthy bone (no bone loss) absorbs most of the X-rays with little or no X-rays passing into the X-ray detector. Osteoporotic bone, on the other hand, absorbs less X-rays with most of the X-rays passing directly through the bone into the X-ray detector. Bone mineral density values as measured by DEXA are expressed in terms of the "T" score - the standard deviation of the bone mineral density value of the patient as compared to normal peak values for young adults.

Measurement of bone mineral density with DEXA has become the standard for diagnosing osteoporosis since 1994. With DEXA, doctors can quantify the amount of bone mineral density and, using the criteria established by the World Health Organization in 1994, group patients into one of the following four categories:

• Normal bone mineral density - T score above -1.0 standard deviation (SD)
• Osteopenia - mild thinning of bone but not enough bone loss to meet the criteria for osteoporosis (T score between -1.0 and -2.5 SD)