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Differential diagnosis must exclude other causes of rarefying bone disease, especially those affecting the spine, such as metastatic cancer and advanced multiple myeloma. The differential diagnosis should also exclude osteomalacia, osteogenesis imperfecta tarda, skeletal hyperparathyroidism, and hyperthyroidism. Initial evaluation attempts to identify the specific cause of osteoporosis through the patient history.
❑ Bone mineral density testing is performed in dual-energy X-ray absorptiometry (DEXA) and measures the mineralization of bones. It’s the gold standard for evaluating osteoporosis.
❑ A spine computed tomography scan shows demineralization. Quantitative computed tomography can evaluate bone density but is less available and more expensive than DEXA.
❑ X-rays show fracture or vertebral collapse in severe cases.
❑ Urine calcium can provide evidence of bone turnover but is limited in value. Newer tests include urinary N-telopeptide to help diagnose osteoporosis.
Source: Professional Guide to Diseases (Eighth Edition), 2005
Differential diagnosis must exclude other causes of rarefying bone disease, especially those affecting the spine, such as metastatic carcinoma and advanced multiple myeloma. Initial evaluation attempts to identify the specific cause of osteoporosis through the patient history. Diagnostic tests include the following:
❑ X-rays show typical degeneration in the lower thoracic and lumbar vertebrae. The vertebral bodies may appear flattened and may look denser than normal.
❑ Bone mineral density (BMD) shows demineralization. Loss of bone mineral becomes evident in later stages.
❑ Dual- or single-photon absorptiometry allows measurement of bone mass, which helps to assess the extremities, hips, and spine.
❑ Serum calcium, phosphorus, and alkaline phosphatase levels are all within normal limits, but parathyroid hormone level may be elevated.
❑ Bone biopsy shows thin, porous, but otherwise normal-looking bone.
Source: Handbook of Diseases, 2003
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