What to Watch For
Osteoporosis, even today, is under-diagnosed and under-treated. Like many deadly diseases, osteoporosis gains much of its power through its ability to progress silently without any apparent signs or symptoms. Bone tissue loss isn't painful in its early stages — everyone experiences it every day. Weak bones don't ache, or creak, or exhibit any other kind of warning. In fact, osteoporosis frequently is diagnosed only after someone suffers a bone fracture. And even then, if the person who suffered the break and/or her doctor doesn't suspect that the break could be related to osteoporosis, and follow up with the proper diagnostic tests, the disease can remain undiagnosed and untreated.
A Very Quiet, Very Large Problem
Osteoporotic bones lose mass very slowly; over time, the bones become so fragile that they can break under very slight strain. Every year, osteoporosis is responsible for:
300,000 hip fractures
700,000 vertebral fractures
250,000 wrist fractures
300,000 fractures at other sites
Some of these figures may be underestimates, since certain fractures aren't even recognized when they occur. The pain resulting from crumbled vertebrae might seem like a back strain, for example. If the broken bone goes unnoticed or, the break is apparent but no one connects it to the disease, osteoporosis continues to erode the bones until another fracture occurs. By the time the warning flag goes up, the disease may have advanced to a critical stage.
Essential
Ninety percent of all hip fractures are associated with osteoporosis and result from a fall. Most falls happen to women in their homes in the afternoon. As you get older and your legs lose strength, your eyesight weakens (especially your peripheral vision), and your balance and flexibility diminish, you're more likely to fall and less able to catch yourself.
Diagnosing the Disease
Because osteoporosis is such a well-hidden disease, your health care provider will turn to your health history (and your family's health history) to determine what your risk factors are for developing the disease. A close review of your osteoporosis risk profile will tell your health care provider how soon (and often) you need to be checked for the development of the disease.
The most common and effective diagnostic tool for osteoporosis is a bone-density measurement known as a bone mineral density (BMD) test. BMD tests can measure the density of the bones in your spine, wrist, heel, and/or hip.
The most common type of bone density test is a dual energy X-ray absorptiometry (DEXA) test. In this test, low-dose X-ray beams scan your lower (lumbar) spine and/or hips for ten to twenty minutes. The test isn't painful, and you're exposed to minimal radiation, so it's a safe and effective diagnostic tool. Other types of bone density scans use ultrasound to measure the bone mass in your heel or wrist, but aren't as conclusive as the DEXA test. However, a quick office scan of the density of your heel or wrist still provides very useful knowledge, especially if you are relatively young (less than forty-five years old), and have risk factors for this condition. This type of peripheral bone density testing is a great screening tool, because it takes fewer than two minutes to perform, and most doctors can conduct the test right in the office during a routine visit.
Besides warning you about osteoporosis before you suffer a fracture, bone-density tests can help you determine your rate of bone loss and help you gauge the effectiveness of your efforts to slow that loss. A BMD test can tell you how your bone density compares to that of healthy bone tissue from a person of your age and — more importantly — to that of an average thirty-year-old.
Alert
Fractures from minor accidents can indicate bone loss. If you have suffered a fracture after a minor fall, you should ask your doctor about conducting a BMD test. Other late signs of osteoporosis occur in many women age sixty-five and older, including stooped shoulders or a loss of height.
