Step By Step – The Osteoporosis Diagnosis

PJ Hamel Health Guide
  • What’s usually the first symptom of osteoporosis?

    A broken bone.

    Sadly, most of us don’t realize we have osteoporosis (let alone its precursor, osteopenia) till we actually suffer a fracture. If we’re “lucky,” it’s something simple, like an ankle (Sonia Sotomayor) or elbow (Hillary Clinton).

    More devastating, though, are hip and spine fractures; injuries that can severely alter your life – or even, ultimately, end it.

    Wouldn’t it be good if we knew osteoporosis was coming, and could prepare for it?

    Well, perhaps if we know what to look for – we can.

    The very first thing that might clue you in to the fact that your bones are losing density could be your posture. Look in the mirror. Do you stand straight and tall, like you did as a teenager – or are you looking kind of “bowed down” or stooped? Inability to stand straight can be an early sign your bones are weakening.

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    Are you having vague, intermittent back pain, and the doctor doesn’t seem to be able to diagnose it? Another possible sign.

    Finally, when you go for your annual physical, does the nurse note that you’ve “shrunk” since last year? Losing height can be a sign of spinal compression fractures – fractures that can happen without you even feeling them.

    You may or may not be experiencing any of these outward signs. If you’re not, that doesn’t necessarily mean your bones are healthy; it just means they’re not breaking down… yet. What’s the first, easiest thing you can do to see if you might be heading towards osteoporosis?

    Get screened at an osteoporosis screening “event.” Portable screening devices are often set up in chain drugstores, perhaps at your town hall, or in other public places. Or perhaps your place of business offers the service as part of the annual health fair. Look for a sign advertising “free osteoporosis screening” at your local hospital or wellness center. And then take advantage of it.

    The test, while fairly basic (it takes a quick X-ray glance at your heel or finger), is surprisingly accurate – as far as it goes. While it obviously doesn’t look at two prime areas for osteoporosis – hip, and spine – screening via a portable device can at least give you a heads-up that you need additional tests.

    So, let’s say that picture of your heel shows some definite bone issues – what next?

    The most reliable osteoporosis diagnostic/screening tool currently available: the DEXA scan.

    All women over the age of 65 should have a baseline DEXA scan, and follow-up scans every 2 years. In addition, women at known risk (family history, a slight frame, use of certain drugs) should be tested sooner.

    Your first scan will serve as your baseline, going forward. It’ll provide you and your doctor with both a T-score (how your bones compare to those of a healthy young adult), and Z-score (how they compare to a healthy person of your own age). Of those, the T-score is more critical; it tells you exactly where you are on the scale: osteopenia (a kind of pre-osteoporosis); on the border; or fully into osteoporosis.


  • If your initial DEXA scan shows that you have osteoporosis (or are heading there quickly), there are a number of other tests your doctor might order. Blood and urine tests can point to what might be causing your condition. Is it lack of vitamin D, critical for calcium absorption? Lack of calcium itself? Is your thyroid, which aids in bone growth, functioning properly? And what about your hormone levels (estrogen in women, testosterone in men)? All of these have an impact on bone health.

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    A blood test can measure vitamin D, calcium, and hormone levels, as well as thyroid function. So, what’s the doctor looking for when he orders a 24-hour urine collection, or other urine test? 

    The most common urine tests, C-telopeptide and N-telopeptide (TEEL-o-PEP-tide), measure how quickly your bones are losing their density. The ALP test (alkaline phosphatase, if you really want to know) measures how quickly (if at all) your bones are adding density.

    Between blood tests and urine tests, the doctor can ascertain pretty accurately why your bones are thinning, and how fast it’s happening. And that information is key in developing a treatment plan.

    Perhaps your calcium and vitamin D are low because you simply don’t get enough in your diet, and you need a supplement. Or perhaps you’re getting plenty of calcium – too much calcium – and your body is simply washing it away. Is lack of estrogen a contributing factor? Would a short course of hormone replacement therapy be beneficial? The blood and urine tests you take will answer these questions.

    And set the stage for your next challenge: preventing additional bone loss.

    Your doctor will make sure you’re getting enough calcium and vitamin D. S/he’ll suggest an exercise program, if you’re not already doing weight-bearing exercises. And you’ll probably start taking a bisphosphonate drug to slow down bone loss. 

    Then, after 6 months or a year – the process will start all over again. You’ll take the same tests to see how the treatment is working.

    And this time, you won’t be wondering, “enteelo wha...?”

Published On: August 23, 2009