Weakening of the bones with osteoporosis is largely asymptomatic, meaning that there are no symptoms, until a fracture occurs. Some patients may experience very vague symptoms which cannot be conclusively identified as being due to osteoporosis without first doing further investigations and excluding other related diseases. It is therefore advisable that a person at high risk of developing osteoporosis, especially the elderly, undergo routine screening to identify the condition at the earliest possible stage.

Symptoms of Osteoporosis

Although osteoporosis is largely asymptomatic, a few key features may be indicators that should warrant further investigation. This includes :

• Unintentional weight loss
• Back pain
• Stooping posture

Loss of height is one of the conclusive symptoms of osteoporosis when it occurs with one or more of the symptoms above. However, even these key features are often missed. It is only when a fracture occurs and imaging studies are done that osteoporosis may first be identified. Both doctors and patients should be alerted to the possibility of osteoporosis when a fracture occurs even with a minor fall that will usually not be considered serious.

Tests for Osteoporosis

There are many types of imaging studies that can be carried out to diagnose osteoporosis. Imaging studies means that the doctor can visualize the bone and even its internal structure through radio waves, magnetic waves or sound waves. Investigations such as a conventional x-ray, CT scan, ultrasound and even MRIs can all help in detecting osteoporosis or identifying a fracture associated with osteoporosis.

Bone Scan

The imaging technique that is most preferred globally is a dual-energy X-ray absorptiometry also commonly referred to as a DEXA scan. The benefits of DEXA compared to other investigations includes :

• Cheaper than some of the other techniques.
• Low radiation exposure.
• Accuracy is fairly good.
• Short procedure time.

The scan is done on the femur (thigh bone), hip and vertebrae (particularly the vertebrae of the low back). DEXA scan returns T-scores and Z-scores on bone mineral density. The T-score system is usually applied to postmenopasal women and men aged 50 years or older who are at a greater risk of primary osteoporosis.

People who should undergo regular DEXA scans irrespective of the symptoms includes :

• Women older than 65 years or even younger women who are post-menopausal.
• Men over the age of 70 years.
• Any person using chronic medication that is known as to cause loss of bone mass.
• Any person who has been diagnosed with osteoporosis.
• Any person using medication for osteoporosis.

In some of these cases, the scans are not meant to diagnose osteoporosis but rather monitor any changes in already diagnosed cases and evaluate the effectiveness of the treatment.

Blood and Urine Tests

There are certain tests that can detect the activity of the bone cells. The osteoblasts build bone while osteoclasts remove bone. Normally the activity of these two cells are kept in check – new bone is being laid down while old bone is resorbed. In osteoporosis this is upset and more bone is being lost than replaced. Certain chemical markers in the blood and urine may be indicative of the activity of the bone cells and can therefore be useful in diagnosing osteoporosis. However, this should not replace a DEXA scan.