How to diagnose osteoporosis?

Osteoporosis is a progressive disease of the skeleton, characterized by a decrease in bone strength that facilitates the development of fractures. It is the second healthcare problem in the world after cardiovascular diseases, according to the World Health Organization (WHO). Its prevalence is increasing given the progressive aging of the population.

During aging the loss of bone mass continues, both at the level of the spine and the hip, which has begun in postmenopause in women, and around 60 years in men. In old age, it is also when the great majority of fractures due to bone fragility occur, whose incidence increases exponentially in those over 75 years of age.

Diagnosis

In all patients with clinical suspicion of osteoporosis should be made an interrogatory, physical examination and a series of complementary examinations, largely aimed at identifying possible underlying processes that determine secondary forms of the disease.

The diagnosis of osteoporosis can be made from the presence of a fragility fracture (low-intensity trauma), but it is very important to diagnose the disease before this complication appears. Therefore, at present the term osteoporosis is used more and more to describe cases of bone mineral density (BMD) decline before any fracture has occurred, calling severe or established osteoporosis to cases where fractures have happened. The asymptomatic condition of osteoporosis then makes the diagnosis depend on, on the one hand, the individual estimation of fracture risk and, on the other, much more objective, on methods that quantify bone mass and assess bone quality. The estimation of the risk of fracture is complicated by the number of involved factors in the etiopathogenesis of the disease, this together with the lack of techniques that measure the quality of bone, means that at present doctors base the diagnosis of osteoporosis mainly on the assessment of BMD.

The only bone measurement technique currently recognized and validated by WHO is double-beam densitometry. The densitometric criteria established by the WHO establish the diagnosis of osteoporosis according to the value of the T-score (taking as reference the peak of bone mass or maximum population value, which is the average of the young adult).

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