[Diagnosis of osteoporosis. How do you manage it?].

For the diagnosis of osteoporosis, conventional X-rays, densitometry and laboratory investigations are available to supplement history-taking and physical examination. The medical history should aim to identify risk factors for osteoporosis which, together with the clinical examination, can provide useful evidence for the presence of secondary osteoporosis. In the first instance, conventional X-rays serve to document osteoporotic fractures, but alone are not suitable for establishing an early diagnosis of osteoporosis. Today, the method of choice for the evaluation of osteoporosis and the fracture risk is densitometry, in particular DEXA (dual energy X-ray absorptiometry). Bone density values of > 2.5 SD (standard deviation) permit the diagnosis of osteoporosis. Currently, such biochemical markers as osteocalcin or hydroxyproline are being investigated for their diagnostic value in terms of disease activity fracture risk and the monitoring of treatment.