Clinical manifestations, diagnosis, and evaluation of osteoporosis in postmenopausal women
- Harold N Rosen, MD
Harold N Rosen, MD
- Assistant Professor in Medicine
- Harvard Medical School
- Marc K Drezner, MD
Marc K Drezner, MD
- Section Editor — Bone Disease
- Professor of Medicine
- University of Wisconsin Medical School
- Section Editors
- Clifford J Rosen, MD
Clifford J Rosen, MD
- Section Editor — Bone Disease
- Professor of Nutrition
- University of Maine
- Professor of Medicine
- Tufts University School of Medicine
- Kenneth E Schmader, MD
Kenneth E Schmader, MD
- Editor in Chief — Geriatric Medicine
- Section Editor — Geriatrics
- Chief, Division of Geriatrics
- Duke University
- Director, Geriatric Research Education and Clinical Center
- Durham VA Medical Centers
Osteoporosis is characterized by low bone mass, microarchitectural disruption, and skeletal fragility, resulting in decreased bone strength and an increased risk of fracture. Decreased bone strength is related to many factors other than bone mineral density (BMD), including rates of bone formation and resorption (turnover), bone geometry (size and shape of bone), and microarchitecture (picture 1). The World Health Organization (WHO) has defined diagnostic thresholds for low bone mass and osteoporosis based upon BMD measurements compared with a young-adult reference population (T-score).
The majority of postmenopausal women with osteoporosis have bone loss related to estrogen deficiency and/or age. The initial evaluation includes a history to assess for clinical risk factors for fracture and to evaluate for other conditions that contribute to bone loss, a physical examination, and basic laboratory tests. Those with abnormal initial findings may require additional testing to detect potentially reversible causes of osteoporosis. In addition, low BMD Z-scores (age-matched comparison) identify individuals requiring further evaluation for secondary causes of osteoporosis.
Early diagnosis and quantification of bone loss and fracture risk are important because of the availability of therapies that can slow or even reverse the progression of osteoporosis.
The clinical manifestations, diagnosis, and evaluation of osteoporosis in postmenopausal women will be reviewed here. The evaluation of osteoporosis in premenopausal women and men and the treatment of osteoporosis are reviewed separately. (See "Evaluation and treatment of premenopausal osteoporosis" and "Clinical manifestations, diagnosis, and evaluation of osteoporosis in men" and "Overview of the management of osteoporosis in postmenopausal women" and "Treatment of osteoporosis in men".)
Osteoporosis has no clinical manifestations until there is a fracture. This is an important fact because many patients without symptoms incorrectly assume that they must not have osteoporosis. On the other hand, many patients with achy hips or feet assume that their complaints are due to osteoporosis. This is unlikely to be true in the absence of fracture. In comparison, pain is common in osteomalacia in the absence of fractures or other bone deformities. (See "Epidemiology and etiology of osteomalacia".)
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- CLINICAL MANIFESTATIONS
- Vertebral fracture
- Other fractures
- Bone mineral density
- - T-score
- - Z-score
- - Applicability of WHO criteria
- - Method of BMD measurement
- - Site of measurement
- DIFFERENTIAL DIAGNOSIS
- EVALUATION OF LOW BONE MASS
- Initial evaluation
- Low Z-scores
- Additional evaluation
- Bone turnover markers
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS