Osteoporosis of the Spine: Diagnostic Tests

Obligatory medical device diagnostics.

  • Osteodensitometry (bone densitometry) – for early diagnosis of osteoporosis and follow-up of therapy, bone density can be determined as follows:
    • Dual-X-ray absorptiometry (DXA, DEXA; dual X-ray absorptiometry; method of first choice)Note: DXA images are not informative in scoliosis. In scoliosis patients, bone density should be measured only at the hip.
    • Quantitative computed tomography (QCT)
    • Quantitative ultrasonography (QUS)

Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification.

  • X-ray of the corresponding region (e.g., thoracic and lumbar spine in two planes) – if fracture (broken bone)* is suspected; however, not suitable for measuring bone density (only when >30% of the bone mass has been lost is osteoporosis recognizable in the X-ray); the following signs may be present:
    • Increased radiolucency
    • Frame/fish/wedge vortex
    • Fractures (e.g., compression and burst fractures)Note: Fresh vertebral body collapses are often not clearly detectable radiologically in the early phase (→ MRI).
  • Magnetic resonance imaging (MRI; computer-assisted cross-sectional imaging method (using magnetic fields, i.e., without X-rays); particularly well suited for changes in the spinal cord as well as for imaging soft tissue lesions) of the spine (cervical/spinal/lumbar MRI) – for assessment of indirect fracture signs or soft tissues (the spinal cord and its sheaths, ligaments, intervertebral discs, and joints), respectively, including for assessment of bone metastases, e.g., of a plasmocytoma (synonyms: Multiple myeloma, Kahler’s disease; plasma cell neoplasia/B-cell non-Hodgkin’s lymphoma).In addition to assessing the spinal cord and its sheaths (and thus detecting the risk of impending spinal cord damage from osseous structures), MRI best allows age determination of a compression fracture. With evidence of bone marrow edema, there is definite evidence of an acute or subacute vertebral body fracture (VC fracture)Note: Bone marrow edema can persist for months!
  • Computed tomography (CT; sectional imaging procedure (X-ray images from different directions with computer-based evaluation), particularly well suited for the depiction of bony injuries) of the spine (cervical spine/spinal cord/lumbar CT).
    • Not for primary diagnostics
    • For the specification of bone density
    • If necessary, for the precise classification of a vertebral body fracture: e.g., to decide whether or not to perform kyphoplasty (minimally invasive procedure for the treatment of vertebral fractures) for stabilization and pain relief in case of WK fractureThe CT thereby enables the reliable assessment of the bony conditions of the spinal canal.

* Vertebral body fracture (vertebral body fracture), femoral neck fracture (femoral neck fracture), distal radius fracture (fracture of the radius near the wrist).

Note: Only about one third of osteoporotic vertebral body fractures are diagnosed clinically! Therefore, radiological diagnosis is always required when an osteoporotic fracture is suspected.

Osteoporosis Screening

  • The U.S. Preventive Services Task Force (USPSTF) advocates osteoporosis screening of women 65 years of age and older to prevent osteoporosis-related fractures (broken bones) (B recommendation).