Signs and Tests

• Bone mineral density (BMD) testing as performed in dual-energy X-ray absorptiometry (DEXA) provides a quantitative measure for demineralization of the bones. This has become the gold standard for evaluation for osteoporosis. BMD testing should be performed on all postmenopausal women with fractures, all women under 65 with an additional risk factor for osteoporosis (besides menopause), and all women 65 and over, as recommended by the National Osteoporosis Foundation.
• A spine CT can show demineralization. Quantitative computed tomography (QCT) can be used to evaluate bone density at a number of sites, but is much less accessible, and is more expensive than DEXA.
• A spine or hip X-ray may show fracture or vertebral collapse in severe cases.
• Measurement of urinary calcium can provide suggestive evidence of increased bone turnover predisposing to osteoporosis, but is of limited clinical utility. A number of newer tests to evaluate bone turnover are becoming available including measurement of urinary N-telopeptide (Osteomark) and may in the future enhance physician's ability to diagnose early osteoporosis.

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