Osteoporosis: An Overview
Osteoporosis Tests and Diagnosis
To make a diagnosis, a doctor will usually take a full medical history, order a bone density test, and possibly other tests.
During an exam, your doctor will:
- Look at your age, consider whether women have reached menopause, whether you have ever broken a bone as an adult, your own family history, and your habits such as drinking, eating, and exercise.
- Ask about which medications you take. Some, such as corticosteroids, can weaken the bones if taken long term.
- Measure you to see if you have lost height. The doctor will inspect your spine. If it abnormally curves forward, that could be a sign that you've already had spinal fractures due to osteoporosis.
The bone density test results will help the doctor decide if you have osteoporosis. The test, which is noninvasive, can measure your bone density at the hip and spine.
Your doctor looks at the results, compares them to standards, and can determine if you have low bone density known as osteopenia, or osteoporosis.
Bone-maintenance drugs can help your bone health. These drugs help maintain bone density and can reduce fracture risk.
Examples of bisphosphonate drugs include:
- alendronate (Fosamax)
- alendronate sodium (Binosto)
- ibandronate (Boniva)
- risedronate (Actonel, Atelvia)
- zoledronic acid (Reclast)
Other drug options to protect against bone loss include:
- raloxifene (Evista): an estrogen-like drug that slows bone loss and helps increase bone thickness
- teriparatide (Forteo): a synthetic form of parathyroid hormone for people with osteoporosis who are considered at high risk for fracture based on a doctor’s assessment
- denosumab (Prolia): An antibody that prevents osteoclast formation, resulting in decreased bone resorption and increased bone mass
If you start taking a bone-maintenance drug, be sure your doctor knows about all other medicines you are on. Some drugs can affect the bones, and your doctor may want to switch you to another drug or adjust the dose.
If you’re taking a bisphosphonate, you may be switched to another drug after five years. That is to avoid the risk, although low, of getting an uncommon thigh bone fracture linked with long-term use of bisphosphonates.
Hormone replacement therapy (HRT) -- either estrogen alone or a combination of estrogen and progestin -- can prevent and treat osteoporosis. The drug Duavee (estrogen and bazedoxifene) is a type of HRT approved to treat menopause-related hot flashes. Duavee may also prevent osteoporosis in high-risk women who have already tried non-estrogen treatment.
However, research has shown that hormone replacement therapy increases the risk of breast cancer , heart disease, and stroke in some women. So while HRT is known to help preserve bone and prevent fractures, it isn't generally recommended at this point for initial treatment of osteoporosis in most women because the health risks are thought to outweigh the benefits.
In women who have been on menopausal hormone therapy in the past and then stopped taking it, the bones begin to thin again -- at the same pace as during menopause.