Signs and Symptoms of Osteoporosis

Osteoporosis usually develops without symptoms until it is severe enough to cause changes in stature, posture or fractures. At that time, osteoporosis may appear as:

• Loss of height
• Kyphosis (extensive flexion "bending forward" of the spine)
• Lordosis (abnormal extension "bending backward" of the spine)
• Fractures of the vertebrae, hip, forearm (may occur spontaneously without any trauma)
• Back pain
• Dowager's hump (humped back)
• Restrictive lung disease (due to multiple thoracic fractures) Abdominal discomfort, constipation, reduced appetite (due to multiple lumbar fractures)

Differential Diagnosis of Osteoporosis

Other medical conditions that can lead to bone weakness and fractures and must be considered in the differential diagnosis of osteoporosis include:

• Vitamin D deficiency
• Metastatic cancer - cancer spreading to bone from a primary site such as the lungs, breast, or prostate
• Multiple myeloma
• Cortisol excess
• Osteoarthritis

Diagnostic Testing for Osteoporosis

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

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

• 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

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

Standard imaging modalities (e.g., plain X-rays; CAT scans; MRI), while useful for diagnosing advanced 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.