Diagnosis of osteoporosis. The utility of radiology, densitometry, ultrasound and markers of bone remodeling

Osteoporosis (OP) is a disease with an important social and healthy impact. Accurate diagnosis leads a better evolution and help to avoid fractures. Besides evaluation of clinical risk factors, as age, early menopause, or family history of OP, the only clinical data are the decrease of height and kyphosis. Acute back pain suggests a recent vertebral fracture and then the diagnosis is the establish OP. X-Ray is only useful for fractures. When fractures have not yet occurred, diagnosis is based in dual energy x-ray absorptiometry (DXA). The World Health Organization defined in 1994 the diagnosis of OP as a bone mass below - 2.5 SD compared with young healthy adults in lumbar spine. The follow-up by DXA, with or without treatment, has not to be made never before one year interval, because the variation coefficient of device has to be considered to reach significant changes. Peripheral devices for bone mass measurement as ultrasounds are easy to use, suitable for previous selection of patients and for epidemiological studies but are not recognized for diagnosis. Biochemical markers of bone turnover are useful tools for monitoring efficacy of antiresorptive and formation therapy but not for diagnosis. Genetic markers are in development and they have not yet used as a establish risk factor. After the diagnosis of fracture other causes of OP and malignancy have to rule out.