II. Indications: Osteoporosis Screening
- All women over age 65 years
- Consider in all men over age 70 years
- Postmenopausal women 60 to 65 years with 1 risk below
- Fracture after age 45 years
- Hip Fracture in a parent
- Tobacco Abuse
- Body Mass Index <22
- Extended gluococorticoid use (>3 months)
- Indications in Men over age 50 and Postmenopausal Women at any age
- Nontraumatic Fracture (esp. hip, Vertebrae, wrist)
- Incidental finding of Osteopenia on plain XRay
- Glucocorticoid use (e.g. Prednisone 5 mg per day for >3 months)
- Hypogonadism
- Hyperparathyroidism
- Multiple Osteoporosis Risk Factors (see below)
- See Osteoporosis Secondary Causes
- Risk Calculators
III. Risk Factors: WHO Model for Fracture Risk (10 year risk)
- Age over 65 in women and over 70 in men
- Female gender
- Personal history of Fracture
- Parental history of Hip Fracture
- Femoral neck Bone Mineral Density (based on DEXA Scan)
- Glucocorticoid use (e.g. Prednisone >5 mg/day for >3 months)
- Current Tobacco Abuse
- Heavy Alcohol use (3 or more drinks per day)
- Body Mass Index <22 kg/m2
- Resources
IV. Risk factors: Osteoporosis
- See Osteoporosis Secondary Causes
- Natural Progression
- Increasing age (over age 65 in women or over age 70 in men)
- Female gender
- Constitutional
- White (fair-skinned) or Asian origin
- Black and Hispanic patients have lower rates
- Low body weight or small stature
- Weight below 58 kilograms in adults
- Body Mass Index (BMI) <22
- White (fair-skinned) or Asian origin
-
Family History
- Parental history of Hip Fracture
- Osteoporosis
- Kyphosis
- Pathologic Fracture
- Lack of Bone loading or Exercise
- Sedentary
- Physical Disability interfering with weight-bearing
- Early Hypogonadism
- Premature Ovarian Failure (e.g. Female Athlete Triad)
- Orchiectomy for Prostate Cancer in men
- Lifestyle
- No longer considered a risk factor
- High phosphate (soda) does not cause Osteoporosis
- Other factors
- Diabetes Mellitus
- Nulliparity
V. Causes: Secondary
VI. Diagnosis
- Keep High level of suspicion in both men and women
- Inquire at routine clinic visits
- Look for spine deformity, pain, and immobility
- Loss of total height measurement
- Women: >4 cm height loss since age 25 years
- Men: >6 cm height loss since age 25 years
- Some use 1.5 inch height loss for criteria
- Evaluation
- Prompts thoracic and Lumbar Spine XRay
- Evaluate for Vertebral Compression Fracture
VII. Imaging
- XRays taken for other reasons
- XRays show changes after 40-50% skeletal mass loss
-
DEXA Scan (single most important BMD testing)
- Can be followed as often as every 2 years
- See DEXA Scan for indications
- Qualitative Ultrasound of Calcaneus
VIII. Labs: Initial at diagnosis (evaluating for Osteoporosis Secondary Causes)
- Complete Blood Count
- Alkaline Phosphatase increased
- Hepatic Aminotransferase levels (AST, ALT) increased
- Hepatic disease
- Serum Albumin decreased
-
Serum Creatinine increased
- Renal disease
- Ionized Serum Calcium
- Increased Calcium
- Hyperparathyroidism
- Cancer
- Decreased Calcium
- Vitamin D Deficiency
- Malabsorption
- Increased Calcium
- Thyroid Stimulating Hormone (TSH) decreased
-
Hypogonadism
- Men: Total Serum Testosterone
- Women: Estradiol
- Consider in pre- or peri-menopausal women
- Unnecessary in post-menopausal women
IX. Labs: High risk for secondary cause
-
Hypercalciuria
- 24 hour Urine Calcium excretion >250 mg
-
Vitamin D Deficiency
- Serum 1,25-Hydroxy Vitamin D decreased
-
Hyperparathyroidism
- Intact Parathyroid Hormone (PTH) increased
- Cushing's Disease
- Multiple Myeloma evaluation
-
Hemochromatosis
- Serum Iron increased
- Ferritin level increased
-
Celiac Sprue
- Tissue transglutaminase and Endomysial antibodies
X. References
- Jeremiah (2015) Am Fam Physician 92(4): 261-8 [PubMed]
- Kanis (1994) J Bone Miner Res 8:1227-34 [PubMed]
- Kleerekoper (1998) Postgrad Med 103(4):45-68 [PubMed]
- Kroger (1998) Ann Med 30:278-87 [PubMed]
- Rosen (1998) Postgrad Med 104(4):101-14 [PubMed]
- Tosteson (2008) Osteoporos Int 19(4):437-47 [PubMed]
- Weber (1998) Endocrinol Metab Clin North Am 27(2):325 [PubMed]
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Related Studies
Concepts | Diagnostic Procedure (T060) |
SnomedCT | 300004007 |
Spanish | cribaje para la detección de osteoporosis, screening para la detección de osteoporosis, pesquisa para la detección de osteoporosis, cribado para la detección de osteoporosis (procedimiento), tamizaje para la detección de osteoporosis, rastreo para la detección de osteoporosis, detección selectiva de osteoporosis (procedimiento), detección selectiva para osteoporosis, screening de osteoporosis, cribado de osteoporosis, cribado para osteoporosis, pesquisa de osteoporosis, tamizaje de osteoporosis, cribado para la detección de osteoporosis, detección selectiva de osteoporosis |
English | Screening for osteoporosis (procedure), for osteoporosis screening, osteoporosis screen, osteoporosis screening, screening for osteoporosis, screening osteoporosis, Screening for osteoporosis |
Ontology: At risk of osteoporosis (C1277579)
Concepts | Finding (T033) |
SnomedCT | 161642002, 138907002, 313423004 |
English | At risk of osteoporosis (finding), At risk of osteoporosis |
Spanish | en riesgo de osteoporosis (hallazgo), en riesgo de osteoporosis |