Osteoporosis. Diagnostics & Treatment
How is osteoporosis identified?
The diagnosis of osteoporosis is based on the patient's personal and family medical history, physical examination, laboratory tests and in particular, on bone density measurement. Osteoporosis in which fractures have already occurred is known as "manifest". If no fractures have yet occurred, the osteoporosis is called "preclinical".
Bone density measurement to identify osteoporosis.
This procedure is used to measure bone mineral density. It is the most common method for determining whether a person has an increased risk of osteoporosis or is already an osteoporosis sufferer. The goal of this measurement is to filter out patients at increased risk before fractures have occurred. The most common and effective test in this respect is dual energy X-ray absorptiometry (DXA). This test provides a precise measurement at the major points in the body (spine, femoral neck and forearm) with a minimal radiation dose. For this test, the patient lies on a table and an x-ray receiver measures the amount of x-ray radiation allowed though by the bones. The test does not cause injury and is pain free. However, insurance funds will only pay for the procedure if fractures have occurred. A DXA is considered indicative of osteoporosis if what is known as the 'T score' is minus 2.5 or less. The lower the score the higher the risk of fracture.
Other procedures for the detection of osteoporosis.
There are also other procedures, such as quantitative computed tomography (Q-CT) or ultrasound examinations of the bone. However, the significance of these methods for determining the risk of fracture has not been studied as much as in the case of DXA.
Basic measures (also for the prevention of osteoporosis).
- Regular physical exercise focusing on muscle strength and coordination, avoid immobilisation
- High-calcium diet (1200-1500mg) calcium per day and, in some cases, additional calcium intake, e.g., with an effervescent tablet
- Sufficient exposure to sunlight for at least 30 minutes daily for the formation of vitamin D and, if necessary, the additional intake of 400-1200 units of vitamin D.
Medication for the treatment of osteoporosis.
The decision to start up a special drug therapy is made by looking at the bone mineral density results in combination with family history, cigarette consumption, the frequency of falls and the possible presence of immobility at that point in time or in the past. Once the decision has been made to start a specific drug therapy based on the entire clinical situation, several drugs can be considered for the treatment of osteoporosis:
These are currently the drugs of first choice. A variety of drugs are currently on the market, from tablets taken once daily to an IV drip that is given once every year. These drugs are able to reduce the risk of fracture by around 50%.
- Strontium ranelate
The risk of fracture can also be halved here.
- Synthetic hormones (so-called SERMs) such as Raloxifene:
This is another treatment alternative that likewise sinks the risk of fracture by around 50%.
- Parathyroid hormone
This form of therapy is only available by injection and is an effective alternative when all other treatment options are not appropriate.
Of course, it should always be checked whether an underlying disease is present that requires a special form of therapy. If this is the case, the special therapy will also frequently improve osteoporosis.
Surgical treatment of a fracture resulting from osteoporosis.
It is possible to inject cement into the vertebra when osteoporosis-induced fractures of the vertebral body are acute, extremely painful and limit range of movement. This can prop the vertebral body up again and reduce excessive curvature in the spine (kyphosis). Two different methods are available:
- Kyphoplasty and
- Vertebroplasty with or without previous balloon expansion