Osteoporosis is sometimes diagnosed incidentally after an X-ray has been taken for a fracture or an illness. If your health care provider suspects you have osteoporosis, he or she may measure you to check for a loss of height. The vertebrae are often the first bones affected, causing a loss in height of half an inch or more. Your health care provider may also recommend that your bone density be measured.
Diagnostic tools more likely to catch osteoporosis at an early stage include various forms of a technique called absorptiometry, which is specifically designed to measure bone density. A relatively new diagnostic tool known as quantitative computerized tomography is also an accurate method of measuring bone density anywhere in the body, but it uses higher levels of radiation than the other methods. Some facilities are also equipped with specialized ultrasound machines that can detect early signs of osteoporosis.
Will a vitamin D test tell me if I need more vitamin D?
That depends on whom you ask. As part of your regular blood test, your doctor can order a test for 25-hydroxyvitamin D (25-OHD).
The problem is not with the test. The problem is how to interpret the results. An expert committee convened by the Institute of Medicine in November 2010 concluded that "the cut-point values used to define deficiency, or as some have suggested, 'insufficiency,' have not been established systematically using data...
In addition to these bone measurement tests, you may be asked to supply blood or urine samples for analysis so that specific diseases that cause osteoporosis can be identified.
What Are the Treatments for Osteoporosis?
Because osteoporosis is difficult to reverse, prevention is the best treatment.
Calcium is the cornerstone of osteoporosis treatment. To help with the absorption of calcium, vitamin D supplements may need to be taken. A regular exercise program -- including weight-bearing exercises, such as walking and aerobics -- can help keep your bones strong and free of fractures.
Menopausal hormone therapy -- either estrogen alone or a combination of estrogen and progestin -- used to be used for prevention and treatment of osteoporosis. However, in July 2002, a landmark study revealed that hormone therapy increases the risk of breast cancer, heart disease, and stroke in some women. Hormone therapy is known to help preserve bone and prevent fractures, but is not generally recommended at this point for osteoporosis because the risks are thought to outweigh the benefits.
In women who have been on menopausal hormone therapy in the past and then stop it, the bone begins to thin again -- at the same pace as during menopause.
Other osteoporosis treatments include:
Evista is a drug that has some actions similar to estrogen, such as the ability to maintain bone mass. However, studies have shown that it doesn't increase the risk of breast or uterine cancers as estrogen does. Evista can cause blood clots and often increases hot flashes.
Actonel, Binosto, Boniva, and Fosamax treat osteoporosis by inhibiting cells that break down bone. There are strict ways to take these medications, because if taken incorrectly, they can lead to ulcers in the esophagus.
Reclast, which is given as a once-yearly 15-minute infusion in a vein, is said to increase bone strength and reduce fractures in the hip, spine and wrist, arm, leg, or rib.
Calcitonin, a naturally occurring hormone that inhibits bone loss, is available as a nasal spray or injection and is quite expensive. Undesirable side effects include nausea and skin rashes.
Forteo is a drug used for the treatment of osteoporosis in postmenopausal women and men who are at high risk for a fracture. A synthetic form of the naturally occurring parathyroid hormone, Forteo is the first drug shown to stimulate new bone formation and increase bone mineral density. It is self-administered as a daily injection for up to 24 months. Side effects include nausea, leg cramps, and dizziness.
Prolia is a monoclonal antibody -- a fully human, lab-produced antibody that inactivates the body's bone-breakdown mechanism. It's the first "biologic therapy" to be approved for osteoporosis treatment. Prolia, a twice-a-year injection, is approved for postmenopausal women at a high risk of fracture when other osteoporosis drugs have not worked.