Diagnosis of osteoporosis
As already mentioned several times, it is important to take prophylactic measures against osteoporosis, since early detection of osteoporosis is often difficult. Osteoporosis therefore often remains undetected for a long time and is only diagnosed when the imbalance between bone formation and resorption causes the first consequences to become apparent. However, early detection would be important in order to minimize the consequences of this disease.
There are different diagnostic procedures for osteoporosis. Some procedures are listed below with their advantages and disadvantages, but the list does not claim to be complete. First of all, it should be mentioned that there are no meaningful biochemical tests that can diagnose osteoporosis.
Specific laboratory values are usually used for further diagnostics and are particularly important in the area of secondary osteoporosis, as it always occurs as a result of a specific underlying disease. The measurement of bone density (= osteodensitometry) can, for example, be used for further diagnosis of radiological suspicion of osteoporosis. This type of examination should be performed especially in high-risk patients, for example patients with family history, late onset of menstruation, early onset of menopause, ovarectomy patients, etc.
This also includes patients who come to the doctor with specific complaints and for whom there are special risks, for example in the form of insufficient calcium or vitamin D intake. Patients with a (visible) lack of exercise and underweight are also particularly at risk. In order for the bone density measurement to provide meaningful results and for the doctor to be able to diagnose changes in bone density, an annual check-up is usually necessary.
As a benchmark for the calculation of the ideal value, the mean bone density values of a healthy 30-year-old person (= T value) are used and compared with the determined value. The stages listed below serve to categorize the severity of osteoporosis. It is worth mentioning that the World Health Organization (WHO) also defines osteoporosis according to the standard deviation of bone mass or density.
- Osteopenia (= low bone mass):Bone mineral content: T value from -1. 0 to – 2. 5 Standard deviation (SD)
- Osteoporosis (without fractures):Bone mineral content: T value < -2.
5 SD
- Manifest osteoporosis (with fractures):Bone mineral content: T value < -2. 5 SD and bone fractures without triggering event such as accident or injury
Computed tomography provides results that can be compared with the results of a bone density measurement. However, the radiation exposure during computed tomography is somewhat higher.
Ultrasound measurement is another way to determine bone density without radiation exposure. At this point, however, it must be noted that the method of measurement using ultrasound is not yet mature enough to be used routinely. The risk of overlooking an O. due to an immature procedure still seems too high at present.
It is therefore another possibility for diagnosis and monitoring of the course of the disease. In addition, however, other measuring methods should be used. Scientific studies have recently pointed to a genetic defect.
This genetic defect is a mutation on the collagen type I-alpha-1 gene. Women with such a genetic defect are said to be three times more likely to suffer from osteoporosis. This genetic defect is associated with the loss of bone mass and the accumulation of bone fractures due to osteoporosis.
Such a genetic defect can be detected with the help of a genetic test. The test can be carried out at any time, i.e. there is no need to wait until the menopause, for example. However, the genetic test can only reveal an increased risk of the disease.
This in turn does not mean that the patient is suffering from osteoporosis in every case or that he will fall ill at some point. Therefore, the genetic test cannot detect the disease as such, but only whether or not the patient is at increased risk.Since the risk of developing osteoporosis is three times higher in the case of a proven genetic defect, the test could play an important role in the prevention of post-menopausal osteoporosis, so that, for example, hormone replacement therapy can be considered early on in high-risk menopausal patients.
