Diagnosis of osteoporosis in clinical practice.

Measurement of bone mineral density is the basis of the diagnosis of osteoporosis. The risk of fracture increases with decreasing bone mineral density, which can be measured using several different techniques. Dual energy x-ray absorptiometry is the most commonly used technique today. A further facility of the new bone densitometry technology is the option for vertebral morphometry. There are errors of accuracy in all bone densitometry techniques and also in the interpretation of the data they provide. Ultrasound of bone may provide new measures of bone fragility. Broadband ultrasound attenuation of the calcaneus predicts the risk of hip fracture in elderly women almost or equally as well as bone densitometry. Ultrasound does not expose to radiation and the equipment is portable. However, bone ultrasound cannot replace bone densitometry. Biochemical bone markers do not differentiate osteoporotic patients from healthy adults. However, they can be useful in deciding on interventions and in monitoring the efficacy of treatment. Their predictive value in individuals suffers from large variability. Biochemistry is widely used in the differential diagnosis of secondary osteoporosis. Suspicion of osteomalacia or an invasive process in the bone marrow are the most common indications for bone biopsy. Finally, although history and physical examination are insufficient in diagnosing primary osteoporosis, they are important in targeting other investigations to exclude secondary forms of osteoporosis.