Bone densitometry to evaluate osteoporosis: Subjects and diagnostic criteria

Osteoporosis is a silent disease, it makes bones weak, bone structure is damaged making bones brittle, easy to break and ultimately fracture. Therefore, early detection and treatment of osteoporosis is a very important and necessary issue.

Osteoporosis-related fractures affect about 1⁄2 white women and 1⁄5 white men in their lifetime. The effects of fracture include loss of function, increased costs of treatment, and increased mortality. The United States Preventive Services Task Force recommends using dual-energy X-ray absorptiometry (DEXA) to screen for osteoporosis for all women 65 years of age and older and younger women at increased fracture risk. increased, as determined by the fracture risk assessment tool FRAX.
In patients with newly diagnosed osteoporosis, suggested laboratory tests to identify a secondary cause include serum 25-hydroxyvitamin D, calcium, creatinine, and thyroid-stimulating hormone.
First-line treatment to prevent fractures includes fall prevention, smoking cessation, alcohol restriction/stopping, and bisphosphonate therapy. Clinicians should consider discontinuing bisphosphonate therapy after 5 years in women with no history of vertebral fractures.
Raloxifene, teriparatide, and denosumab are effective alternative treatments for certain groups of patients and for those unable to take or whose condition is unresponsive to bisphosphonates. The need for subsequent bone mineral density testing in patients being treated for osteoporosis is uncertain.

Excessive alcohol consumption (> 4 drinks per day for men; > 2 drinks per day for women), caffeine use (> 2.5 cups of coffee per day) and tobacco use (any smoking ). Personal history of fracture, family history of osteoporosis fractures Prolonged use of corticosteroids (> 3 months). Diet lacking calcium or vitamin D. Gonadal hormone deficiency Old age Thin, low body weight (body mass index BMI < 20 kg/m2). Low levels of physical activity Caucasian or Asian race Recommendation from The wisely campaign
Do not use dual-energy X-ray absorptiometry (DEXA) to screen for osteoporosis in women under 65 years of age or in men younger than 70 years of age with no risk factors. Do not repeat dual-energy X-ray absorptiometry (DEXA) osteoporosis measurements more often than every two years. Osteoporosis Screening Subjects
Published osteoporosis screening guidelines vary widely. The United States Preventive Medicine Task Force (USPSTF) recommends screening all women 65 years of age and older. The DEXA measurement of the lumbar spine and femur is the evaluation method of choice. The USPSTF also recommends screening for osteoporosis in women younger than 65 years of age with a 10-year fracture risk greater than or equal to that of women over 65 years of age without other risk factors. The FRAX fracture risk assessment tool has been used by the USPSTF as a method of determining fracture risk for these women.
Recommended subjects to screen for osteoporosis

Primary osteoporosis associated with aging and loss of gonadal function. Osteoporosis secondary to other health conditions. Up to 30% of osteoporosis cases in postmenopausal women are estimated to be due to secondary causes. It is estimated to increase to more than 50% in men, premenopausal and perimenopausal women with vitamin D deficiency. Tests commonly recommended to identify secondary osteoporosis include serum 25-hydroxyvitamin D , calcium, creatinine and thyroid-stimulating hormone levels.

Osteoporosis is diagnosed by X-ray based on determination of bone mineral density (BMD) by DEXA technique.
The World Health Organization (WHO) has established commonly accepted definitions of osteoporosis and osteoporosis
Diagnostic criteria for osteoporosis (Osteoporosis) and osteoporosis (Osteopenia) in postmenopausal women and Men older than 50 years old

Osteoporosis is when your bone mineral density is lower than normal but not to the point of breaking like osteoporosis.
WHO criteria should not be applied to men under 50 years of age, children or women who have not gone through menopause. For these groups, the International Society for Clinical Densitometry recommends the use of a Z-score. The Z-score compares your bone density to the average for someone your age and gender. A Z-score ≤ −2.0 is a warning sign that you have less bone mass (and/or possibly faster bone loss) than expected for people of the same age and sex.
Osteoporosis in men under the age of 50 cannot be diagnosed based on bone density (BMD) assessment alone.
Osteoporosis causes many serious consequences, reducing the quality of life and life expectancy of patients. Therefore, it is best for each person to apply the above osteoporosis prevention treatments to have a strong skeleton - the foundation for flexible mobility, good health and long life.
Patients with osteoporosis can go to Vinmec International General Hospital for examination and treatment. There is a team of musculoskeletal specialists who are well-trained, experienced and professional; system of modern equipment, meeting international standards; Professional service quality, high efficiency in diagnosis and treatment.

Reference source: aafp.org