Molecular structure pattern

Osteoporosis Công cụ chẩn đoán

Cập nhật: 29 September 2025
Được đánh giá bởi

Laboratory Tests and Ancillaries

Laboratory tests include complete blood count (CBC), erythrocyte sedimentation rate (ESR), renal function tests (eg blood urea nitrogen [BUN], creatinine), liver function tests (LFTs), electrolytes (eg ionized calcium, phosphate, magnesium), serum 25-hydroxyvitamin D, total protein, albumin, aspartate aminotransferase (AST), alkaline phosphatase, urinalysis, urinary N-telopeptide (uNTX), and 24-hour urinary calcium.

Bone turnover markers may be considered in the primary evaluation and follow-up of patients with osteoporosis. Elevated levels indicate rapid bone loss and identify patients at high risk for fractures. This is used to evaluate efficacy and compliance with current treatment. Examples of bone turnover markers include serum C-telopeptide (CTX), osteocalcin, N-terminal propeptide of type 1 procollagen (P1NP), tissue transglutaminase antibodies (IgA and IgG), and serum protein electrophoresis (SPEP). Other tests (eg thyroid function as indicated, PTH, and total and free testosterone) may be done.

Imaging

Bone Mineral Density (BMD) Measurements

Bone mineral density measurements give an accurate reflection of bone mass and confirm the diagnosis of osteoporosis. These measurements are an excellent predictor of future fracture risk. For each standard deviation (SD) reduction in BMD, there is approximately a twofold increased risk of fracture. These are recommended when results would affect management. Bone mineral density measurements can identify patients for possible pharmacologic therapy. These are used for therapeutic monitoring in patients with glucocorticoid-induced osteoporosis (GIOP).

Methods of BMD Measurement

DXA of Hip and Spine

DXA of the hip and spine is the gold standard for diagnosing osteoporosis with a hip and/or spine DXA BMD T-score of ≤-2.5. This is also used to monitor therapeutic response based on bone mineral density of the spine and fracture risk assessment based on DXA measurement at the hip in patients with GIOP.

WHO Recommended Values2 for Diagnosis of Osteoporosis
BMD T-score (SD) Definition
T ≥ -1 Normal
-2.5 < T < -1 Osteopenia (low bone mass)
T ≤ -2.5 Osteoporosis
T ≤ -2.5 + fragility fracture Severe/established osteoporosis

1Should be used for postmenopausal women and men ≥50 years old
2Values are based on DXA 
T-score: A comparison with young normal adult mean of the same sex

                       BMD Z-Score3

 BMD Z-score (SD)  Definition
 ≥ -2.0  Within the expected range for age
 ≤ -2.04  Below the expected range for age

3Should be used for premenopausal women, men <50 years old and children
4For premenopausal women and men <50 years old, consider screening for secondary causes of osteoporosis




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Quantitative CT scan (QCT)

A quantitative CT scan is used as an alternative technique when DXA is not available. This measures bone strength in the axial skeleton and volumetric bone density of the vertebra and hip. This has a higher radiation dose compared to DXA.

Trabecular Bone Score (TBS)

The Trabecular Bone Score (TBS) evaluates the microarchitectural texture of the bone and is highly sensitive in predicting fracture risk.

Screening Methods (Not for Diagnosis or Monitoring)

Screening methods not for diagnosis or monitoring include:

  • Peripheral DXA (pDXA)
  • CT-based assessments: Peripheral QCT
  • Quantitative ultrasound densitometry (QUS) of heel, tibia, patella, and other peripheral skeletal sites

Radiology

Scintigraphic bone studies and X-rays of the lateral thoraco-lumbar spine or hip (as indicated) may be done. Bone loss of >30% is seen as radiological osteopenia in plain X-rays. Postmenopausal women and men at risk of vertebral fracture are recommended to undergo DXA or lateral spine X-ray.



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Vertebral Imaging

Vertebral imaging is recommended for the following: 

  • Women ≥70 years and men ≥80 years with BMD T-score ≤-1.0 at the spine, total hip, or femoral neck
  • Women 65-69 years and men 70-79 years with BMD T-score ≤-1.5 at the spine, total hip, or femoral neck
  • Postmenopausal women and men ≥50 years old with low-trauma fracture during adulthood, historical height loss (current height – peak height at 20 years) by >1.5 inches, prospective height loss (current height – recently documented height) by ≥0.8 inches, and/or currently or previously on long-term glucocorticoid treatment
  • Other bone mineral density measurements are unavailable