Diagnosis of osteoporosis: Diagnostic work-up and secondary causes of osteoporosis

Abstract

Learning Outcome 1: To understand secondary causes of osteoporosis. Learning Outcome 2: To understand the diagnosis of osteoporosis. Learning Outcome 3: To be familiar with investigations to exclude secondary osteoporosis. Abstract: Assessment of the patient with suspected osteoporosis should start with a clinical history and examination. Risk factors for osteoporosis should be sought and examination should be performed to establish whether abnormal physical signs such as a dorsal kyphosis are present. Fracture risk assessment should be performed using clinical risk factors and, if indicated, bone mineral density (BMD) using dual energy X-ray absorptiometry (DXA). In patients with height loss, spinal deformity, or low BMD vertebral imaging using either conventional radiography or DXA should be performed to detect whether vertebral fractures are present. Secondary causes of osteoporosis may be present in up to 30% or women and 55% of men, and aremost common in patients with vertebral fracture. It is therefore important to exclude underlying conditions that may contribute to low BMD and fracture. These include endocrine disorders (hypogonadism, hyperthyroidism, hyperparathyroidism, glucocorticoid excess), osteomalacia, malignant disease particularly myeloma, drugs including glucocorticoids, aromatase inhibitors and androgen deprivation therapy, gastrointestinal disease, chronic liver, lung or renal disease, connective tissue disorders and immobility. Initial investigations in all patients should include full blood count and ESR, bone biochemistry and renal and liver function tests. In addition, serum TSH and coeliac serology should be performed and serum testosterone measured in men. In patients with vertebral fractures, myeloma should be excluded using serum protein immunoelectrophoresis. Further tests should be performed if indicated by abnormalities in the initial blood tests or by clinical history and examination. This article is part of a Special Issue entitled ECTS 2012. Disclosure of interest: None declared.