Osteoporosis: Diagnosis and Treatment

Diagnosis

• The evaluation will begin with a medical history and a physical examination.
  
• Bone density testing (DEXA scan) establishes the diagnosis of osteoporosis.
  
• X–rays will generally identify bone fractures. In some cases, a CT scan or bone scan may be necessary.
  
• Bone biopsy is rarely performed.
  
• Blood tests may be necessary if there is suspicion of an underlying disease.

Treatment

• Lifestyle modification is an important component of therapy. Healthful dietary and exercise habits help maintain bone integrity and reduce bone loss later in life (see Nutritional Considerations).
  
  Regular weight–bearing and resistance exercise (at least three times a week) increases the bone mineral density of the spine.
  
  Smoking cessation has been associated with decreased risk of hip fracture. Smoking increases the risk of developing a hip fracture by more than 30 percent in women and 40 percent in men, and increases the risk for spinal fracture.
  
• Medications may be used to reduce bone loss, improve bone density, and reduce the fracture risk.
  
  Medications used to decrease bone loss include bisphosphonates (e.g., alendronate, pamidronate, risedronate, and ibandronate), raloxifene, calcitonin, and estrogens. These medications must be taken with adequate amounts of calcium and vitamin D.
  
  Estrogen use slows progression of osteoporosis. However, the benefits of estrogens must be weighed against the many possible adverse effects of estrogen therapy, particularly the increased risk of breast cancer, blood clots, and heart disease.
  
  Other medications that may be used include testosterone, thiazide diuretics (e.g., hydrochlorothiazide), and teriparatide.