When to measure bone density to diagnose osteoporosis?

At present, everyone is afraid of osteoporosis and massively measures osteoporosis (LX). However, we need to be aware that any diagnostic method has its limitations and can even bring about time and money and buy more anxiety, fear .

Why is bone density measurement needed to diagnose LX?

Bone density measurement for patients at the Geriatrics Institute (Photo: TTO) LX is a pathological condition of the skeletal system characterized by a decrease in bone mass (ie, a decrease in bone mineral density, primarily calcium ), combined with the microstructural mutation of bone organization, makes bones brittle and at risk of fracture. In theory, to diagnose the LX must simultaneously evaluate both factors: bone mineralization density and bone microstructure .

There are many methods to diagnose LX. The first is the method of assessing the structure of bone directly (through bone biopsy), or indirectly (using nuclear magnetic resonance method to evaluate bone structure in three-dimensional space). Bone biopsy to diagnose LX causes pain, only performed in the pelvic bone, so it cannot be universal. Nuclear magnetic resonance methods are expensive, so there is no clinical application, but only in scientific studies.

Clinical diagnosis is often delayed because LX progresses quietly, asymptomatically and can only occur in the late stages, when there are complications. It is spinal pain due to subsidence, accompanied by a decrease in height, hunchback or fracture of the femur, wrist, pelvis, ribs. These complications require long-term, expensive treatment, with high mortality rates.

The method of X-ray diagnosis also only allows diagnosis when bone density has been lost by 30-50%. Therefore, X-ray is not indicated for the diagnosis of LX. Biochemical tests to assess bone turnover (bone formation and bone destruction) are costly and do not allow the assessment of bone density as well as the risk of bone fractures. Therefore, it is not recommended to use bone transfer markers to diagnose and monitor treatment.

Currently the World Health Organization (WHO 1994) regulates the use of methods to measure bone mineralization density for diagnosis of osteoporosis. Bone density measurement also allows diagnosis of osteoporosis at an early stage, when there are no serious complications such as fractures. Therefore bone density measurement (BMD) is considered the gold standard for diagnosing LX.

Who needs to measure BMD?

The first is those who are at high risk of developing osteoporosis. These are the elderly, white or Asian, with a history of fractures after 40-45 years of age, a family history of fracture or osteoporosis, prolonged immobility or little physical activity, or body weight low (BMI

Some authors argue that women who do not use replacement hormones in the first five years after menopause are also at higher risk of osteoporosis. There is no need to measure BMD in all postmenopausal women. Just need to measure BMD in early menopausal women before age 40 or normal menopausal women with a history of pathology that can cause secondary LX (prolonged hypogonadism, untreated hyperthyroidism, intense adrenal cortex and primary hyperthyroidism.

Next, it is necessary to measure BMD in people with clinical manifestations suspected of subsidence subsidence, reduced height, hunch, or broken hands and feet, not due to any serious injury.

When to repeat the measurement of BMD?

If there is no indication for treatment after the BMX measurement, only repeat BM measurement after 2-3 years, 4 years of kidney failure. In order to detect changes in BMD 2-3%, it takes 1-1.5 years if the error is 1%, and 5 years if the error of the machine is 5%. When measuring again, it should be measured at the same machine on the same location.

In the case of treatment, repeat measurements of BMX in the lumbar spine can be measured because the effect of the drug in this position is quite obvious.

In addition to measuring BMD, what other factors should be paid attention to?

There are many other factors that cause bone fractures, not just BMD. These are risk factors for fracture, it is very easy to lead to fracture of the femur such as: weak vision, motion reduction due to immobilization, inappropriate environment (all things that cause falls at home), reduced strength ( difficulty climbing stairs, reducing knee stretching, or quadriceps muscle pressure, treating tranquilizers or affecting ability to keep balance. The type of falls, height, femur length is also a risk factor not dependent on BMD.

In short, BMD should only be measured in people at high risk of osteoporosis or suspected LX. Only then will the BMX measure its full effect.