Skip to main content

Diagnosing Osteoporosis

  • Chapter
  • First Online:
  • 1438 Accesses

Part of the book series: Current Clinical Practice ((CCP))

Abstract

Although the number of applications for bone densitometry has grown rapidly in the last few years, the use of densitometry to diagnose osteoporosis remains the most common application in clinical practice. What constitutes a diagnosis of osteoporosis, however, has continued to evolve.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Notes

  1. 1.

    See Chapter 10 for a discussion of FRAX™, the 10-year absolute fracture risk prediction algorithm from the World Health Organization.

  2. 2.

    See Chapter 1 for a discussion of densitometry techniques.

  3. 3.

    Broadband ultrasound attenuation, expressed as dB/MHz

  4. 4.

    Speed of sound, expressed as m/s

  5. 5.

    At this NIH Consensus Conference osteoporosis was defined as a “skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture.”

  6. 6.

    The European Prospective Osteoporosis Study.

  7. 7.

    Although ISCD does not recommend the use of the WHO criteria with trochanteric bone density measurements, the site does provide useful information when osteoarthritis of the hip joint makes results from the total hip and femoral neck suspect.

References

  1. Consensus Development Conference. Prophylaxis and treatment of osteoporosis. Am J Med 1991;90:107–110.

    Article  Google Scholar 

  2. Consensus Development Conference. Diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 1993; 94:646–650.

    Article  Google Scholar 

  3. World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO technical report series. Geneva: WHO, 1994.

    Google Scholar 

  4. Personal communication. Dr. John Kanis to Dr. Leon Lenchik, March 29, 1999.

    Google Scholar 

  5. Genant HK, Cooper C, Poor G, et al. Interim report and recommendations of the World Health Organization Task-Force for osteoporosis. Osteoporos Int 1999;10:259–264.

    Google Scholar 

  6. WHO. Prevention and management of osteoporosis. [921], 1–192. 2003. Geneva, WHO. WHO Technical Report Series.

    Google Scholar 

  7. Kanis JA, Gluer C-C. An update on the diagnosis and assessment of osteoporsois with densitometry. Committee of Scientific Advisors, International Osteoporosis Foundation. Osteoporos Int 2000;11:192–202.

    Article  PubMed  CAS  Google Scholar 

  8. Hamdy RC, Petak SM, Lenchik L. Which central dual x-ray absorptiometry skeletal sites and regions of interest should be used to determine the diagnosis of osteoporosis? J Clin Densitom 2002;5:S11–S17.

    Article  PubMed  Google Scholar 

  9. Hans D, Downs RW, Duboeuf F, et al. Skeletal sites for osteoporosis diagnosis: the 2005 ISCD official positions. J Clin Densitom 2006;9:15–21.

    Article  PubMed  Google Scholar 

  10. Miller PD, Njeh CF, Jankowski LG, Lenchik L. What are the standards by which bone mass measurement at peripheral sites should e used in the diagnosis of osteoporosis? J Clin Densitom 2002;5:S39–S45.

    Article  PubMed  Google Scholar 

  11. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 1996;312:1254–1259.

    Article  PubMed  CAS  Google Scholar 

  12. Cummings SR, Black DM, Nevitt MC, et al. Bone density at various sites for prediction of hip fracture. Lancet 1993;341:72–75.

    Article  PubMed  CAS  Google Scholar 

  13. Melton LJ, Atkinson EJ, O’Fallon WM, Wahner HW, Riggs BL. Long-term fracture prediction by bone mineral assessed at different skeletal sites. J Bone Miner Res 1993;8:1227–1233.

    Article  PubMed  Google Scholar 

  14. Miller PD, Siris ES, Barrett-Connor E, et al. Prediction of fracture risk in postmenopausal white women with peripheral bone densitometry: evidence from the National Osteoporosis Risk Assessment. J Bone Miner Res 2002;17:2222–2230.

    Article  PubMed  Google Scholar 

  15. Greenspan SL, Maitland-Ramsey L, Myers E. Classification of osteoporosis in the elderly is dependent on site-specific analysis. Calcif Tissue Int 1996;58:409–414.

    Article  PubMed  CAS  Google Scholar 

  16. Varney LF, Parker RA, Vincelette A, Greenspan SL. Classification of osteoporosis and osteopenia in postmenopausal women is dependent on site-specific analysis. J Clin Densitom 1999;2:275–283.

    Article  PubMed  CAS  Google Scholar 

  17. Faulkner KG, von Stetten E, Miller P. Discordance in patient classification using T-scores. J Clin Densitom 1999;2:343–350.

    Article  PubMed  CAS  Google Scholar 

  18. Pouillès JM, Tremollières FA, Martinez S, Delsol M, Ribot C. Ability of peripheral DXA measurements of the forearm to predict low axial bone mineral density at menopause. Osteoporos Int 2001;12:71–76.

    Article  PubMed  Google Scholar 

  19. Mulder JE, Michaeli D, Flaster ER, Siris E. Comparison of bone mineral density of the phalanges, lumbar spine, hip, and forearm for assessment of osteoporosis in postmenopausal women. J Clin Densitom 2000;3:373–381.

    Article  PubMed  CAS  Google Scholar 

  20. Fiter J, Nolla JM, Gómez-Vaquero C, Martínez-Aguilá D, Valverde J, Roig-Escofet D. A comparative study of computed digital absorptiometry and conventional dual-energy x-ray absorptiometry in postmenopausal women. Osteoporos Int 2001;12:565–569.

    Article  PubMed  CAS  Google Scholar 

  21. Damilakis J, Persinakis K, Gourtsoyiannis N. Imaging ultrasonometry of the calcaneus: optimum T-score thresholds for the identification of osteoporotic subjects. Calcif Tissue Int 2001;68:219–224.

    Article  PubMed  CAS  Google Scholar 

  22. Fordham JN, Chinn DJ, Kumar N. Identification of women with reduced bone density at the lumbar spine and femoral neck using BMD at the os calcis. Osteoporos Int 2000;11:797–802.

    Article  PubMed  CAS  Google Scholar 

  23. Pacheco EMB, Harrison EJ, Ward KA, Lunt M, Adams JE. Detection of osteoporosis by dual energy X-ray absorptiometry (DXA) of the calcaneus: is the WHO criterion applicable? Calcif Tissue Int 2002;70:475–482.

    Article  PubMed  CAS  Google Scholar 

  24. Sweeney AT, Malabanan AO, Blake MA, et al. Bone mineral density assessment: comparison of dual-energy x-ray absorptiometry measurements at the calcaneus, spine and hip. J Clin Densitom 2002;5:57–62.

    Article  PubMed  Google Scholar 

  25. Consensus Conference. Osteoporosis prevention, diagnosis, and therapy. JAMA 2001;285:785–795.

    Article  Google Scholar 

  26. Lu Y, Genant HK, Shepherd J, et al. Classification of osteoporosis based on bone mineral densities. J Bone Miner Res 2001;16:901–910.

    Article  PubMed  CAS  Google Scholar 

  27. Black DM. A proposal to establish comparable diagnostic categories for bone densitometry based on hip fracture risk among Caucasian women over age 65. Abstract. J Bone Miner Res 2001;16:S342.

    Google Scholar 

  28. Blake GM, Fogelman I: Peripheral or central densitometry: does it matter which technique we use? J Clin Densitom 2001;4:83–96.

    Article  PubMed  CAS  Google Scholar 

  29. Faulkner KG, Orwoll E. Implications in the use of T-scores for the diagnosis of osteoporosis in men. J Clin Densitom 2002;5:87–93.

    Article  PubMed  Google Scholar 

  30. Binkley NC, Schmeer P, Wasnich RD, Lenchik L. What are the criteria by which a densitometric diagnosis of osteoporosis can be made in males and non-Caucasians? J Clin Densitom 2002;5:S19–S27.

    Article  PubMed  Google Scholar 

  31. The European Prospective Osteoporosis Study (EPOS) Group. The relationship between bone density and incident vertebral fracture in men and women. J Bone Miner Res 2002;17:2214–2221.

    Article  Google Scholar 

  32. De Laet CEDH, Van Der Klift M, Hofman A, Pols HAP. Osteoporosis in men and women: a story about bone mineral density thresholds and hip fracture risk. J Bone Miner Res 2002;17:2231–2236.

    Article  PubMed  Google Scholar 

  33. Melton LJ, Orwoll ES, Wasnich RD. Does bone density predict fractures comparably in men and women? J Bone Miner Res 2001;12:707–709.

    Google Scholar 

  34. Liu G, Peacock M, Eilam O, Dorulla G, Braunstein E, Johnston CC. Effect of osteoarthritis in the lumbar spine and hip on bone mineral density and diagnosis of osteoporosis in elderly men and women. Osteoporos Int 1997;7:564–569.

    Article  PubMed  CAS  Google Scholar 

  35. Frye MA, Melton LJ, Bryant SC, et al. Osteoporosis and calcification of the aorta. Bone Miner 1992;19:185–194.

    Article  PubMed  CAS  Google Scholar 

  36. Frohn J, Wilken T, Falk S, Stutte HJ, Kollath J, Hor G. Effect of aortic sclerosis on bone mineral measurements by dual-photon absorptiometry. J Nucl Med 1990;32:259–262.

    Google Scholar 

  37. Orwoll ES, Oviatt SK, Mann T. The impact of osteophytic and vascular calcifications on vertebral mineral density measurements in men. J Clin Endocrinol Metab 1990;70:1202–1207.

    Article  PubMed  CAS  Google Scholar 

  38. Reid IR, Evans MC, Ames R, Wattie DJ. The influence of osteophytes and aortic calcification on spinal mineral density in post-menopausal women. J Clin Endocrinol Metab 1991;72:1372–1374.

    Article  PubMed  CAS  Google Scholar 

  39. Drinka PJ, DeSmet AA, Bauwens SF, Rogot A. The effect of overlying calcification on lumbar bone densitometry. Calcif Tissue Int 1992;50:507–510.

    Article  PubMed  CAS  Google Scholar 

  40. Cherney DD, Laymon MS, McNitt A, Yuly S. A study on the influence of calcified intervertebral disk and aorta in determining bone mineral density. J Clin Densitom 2002;5:193–198.

    Article  PubMed  Google Scholar 

  41. Nevitt MC, Lane NE, Scott JC, et al. Radiographic osteoarthritis of the hip and bone mineral density. Arth Rheum 1995;38:907–916.

    Article  CAS  Google Scholar 

  42. Preidler KW, White LS, Tashkin J, et al. Dual-energy X-ray absorptiometric densitometry in osteoarthritis of the hip. Influence of secondary bone remodeling of the femoral neck. Acta Radiol 1997;38:539–542.

    PubMed  CAS  Google Scholar 

  43. Hans D, Biot B, Schott AM, Meunier PJ. No diffuse osteoporosis in lumbar scoliosis but lower femoral bone density on the convexity. Bone 1996;18:15–17.

    Article  PubMed  CAS  Google Scholar 

  44. Bonnick SL, Nichols DL, Sanborn CF, Payne SG, Moen SM, Heiss CJ. Right and left proximal femur analyses: is there a need to do both? Calcif Tissue Int 1996;58:307–310.

    PubMed  CAS  Google Scholar 

  45. Rao AK, Reddy S, Rao DS. Is there a difference between right and left femoral bone density? J Clin Densitom 2000;3:57–61.

    Article  PubMed  CAS  Google Scholar 

  46. Petley GW, Taylor PA, Murrills AJ, Dennison E, Pearson G, Cooper C. An investigation of the diagnostic value of bilateral femoral neck bone mineral density measurements. Osteoporos Int 2000;11:675–679.

    Article  PubMed  CAS  Google Scholar 

  47. Mazess RB, Nord RH, Hanson JA, Barden HS. Bilateral measurement of femoral bone mineral density. J Clin Densitom 2000;3:133–140.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sydney Lou Bonnick MD, FACP .

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Humana Press, a part of Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Bonnick, S.L. (2010). Diagnosing Osteoporosis. In: Bone Densitometry in Clinical Practice. Current Clinical Practice. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-499-9_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-60327-499-9_9

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60327-498-2

  • Online ISBN: 978-1-60327-499-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics