| Bone is a living tissue that undergoes constant | | | | After the history, a careful physical examination |
| change. This series of changes is called | | | | looking for specific causes of bone loss such as |
| "remodeling." Old bone is removed and new bone | | | | thyroid disease, vitamin deficiency, or other |
| is formed. | | | | conditions should be performed. |
| The structure of bone consists of a matrix | | | | Then, a full laboratory workup consisting of |
| composed of a framework of collagen and | | | | complete blood count, erythrocyte sedimentation |
| minerals. While the character of bone is different | | | | rate (ESR), thyroid blood tests, blood chemistries, |
| in different areas of the skeleton, the common | | | | urinalysis, serum vitamin D levels, and 24 hour |
| thread is that if the collagen framework or the | | | | urine tests measuring calcium and phosphorus |
| minerals aren't properly remodeled, then bone | | | | should be obtained. |
| quality is compromised. This leads to an increased | | | | If there is evidence of fracture in the spine, |
| risk for fracture. The typical situation- and the one | | | | x-rays may be obtained. Some people may have |
| that is responsible for post-menopausal | | | | what are called insufficiency fractures. These are |
| osteoporosis- is that too much bone tissue is | | | | fractures that develop spontaneously in people |
| removed and not enough is built. When this | | | | with very low bone strength. Often these types |
| abnormal bone is subjected to daily wear and | | | | of fractures will not show up on regular x-ray. |
| tear, "microcracks" in the bone accumulate leading | | | | Bone scans and magnetic resonance imaging (MRI) |
| to fracture. | | | | may then be required. Special urine tests for bone |
| The first place to start if you suspect you may | | | | markers may also be ordered. These urine tests |
| be at risk for osteoporosis is to find the right kind | | | | may yield a clue that bone is undergoing improper |
| of doctor. This is usually a rheumatologist who | | | | remodeling. |
| specializes in osteoporosis. | | | | A bone density scan (also called a dual-energy |
| He or she will take a careful history looking for | | | | x-ray absorptiometry scan or DEXA) is |
| risk factors. Among the most common are: | | | | mandatory! These scans should be interpreted by |
| female gender, advancing age, family history, | | | | a trained rheumatologist. This scan measures the |
| small body frame, Caucasian or Asian race, | | | | actual "thickness" of bone. DEXA scans are also |
| chronic kidney or bowel disease, cigarette | | | | an excellent method for evaluating the |
| smoking, alcoholism, high caffeine intake, and | | | | effectiveness of drug therapy... once the patient |
| chronic steroid or blood thinner therapy. | | | | has been started on the proper medication. |
| Other medical conditions which may be associated | | | | In some instance, a bone biopsy may be required. |
| with osteoporosis are diabetes, overactive thyroid | | | | This procedure involves the extraction of a plug |
| disease, lung disease, alcoholism, and hormone | | | | of bone from the pelvis. This is done using local |
| (estrogen or testosterone) deficiency. | | | | anesthetic and provides a specific look at bone |
| Ideally, a careful history evaluating a patient's risk | | | | architecture. |
| for falls should also be taken. Impaired vision and | | | | In future articles, treatment of osteoporosis will |
| environmental hazards such as poor lighting in the | | | | be discussed. |
| home, etc. should be looked into. | | | | |