Osteoporosis Diagnosis 9/21/2018 OSTEOPOROSIS

NOF 9/21/2018 OSTEOPOROSIS

Diagnosis Osteoporosis S P I N E 9/21/2018 OSTEOPOROSIS

SPINE Outside look Inside structure NORMAL or OSTEOPOROTIC 9/21/2018 OSTEOPOROSIS

Osteoporosis by looking at the teeth You can not diagnose Osteoporosis by looking at the teeth 9/21/2018 OSTEOPOROSIS

Diagnosis of Postmenopausal Osteoporosis (PMO): Clinical Evaluation Medical history  Risk factor assessment Physical examination Height assessment Laboratory tests, as appropriate Bone mineral density (BMD) testing 9/21/2018 OSTEOPOROSIS

Osteoporotic Patient Diagnosis Osteoporosis 9/21/2018 OSTEOPOROSIS

Types of Vertebral fractures Diagnosis Osteoporosis Types of Vertebral fractures Normal Concave deformity Wedge Fracture Compression Fracture 9/21/2018 OSTEOPOROSIS

Lumbar Vertebrae: PATHOLOGY Diagnosis Osteoporosis Lumbar Vertebrae: PATHOLOGY Osteoporotic (Fractured) vertebra From Remagen W 1989, Sandoz 9/21/2018 OSTEOPOROSIS

Spinal CT vertebral body Abnormal Normal No Bone left inside 9/21/2018 OSTEOPOROSIS

Routine Blood work: NORMAL Diagnosis Osteoporosis Osteoporosis Routine Blood work: NORMAL Including biochemical bone profile 9/21/2018 OSTEOPOROSIS

NOT an easy test to interpret Diagnosis Osteoporosis Bone Markers NOT an easy test to interpret AM PM 9/21/2018 OSTEOPOROSIS

9/21/2018 OSTEOPOROSIS

Testing Bone Strength Oh, no 9/21/2018 OSTEOPOROSIS

… instead, we measure Bone Mineral Density 9/21/2018 OSTEOPOROSIS

… we only measure the minerals Which means… … we only measure the minerals 9/21/2018 OSTEOPOROSIS

NOF 9/21/2018 OSTEOPOROSIS

DXA is the gold standard Densitometer 9/21/2018 OSTEOPOROSIS

DXA images / Reports Spine Hip Total Body 9/21/2018 OSTEOPOROSIS

Forget the Ward’s triangle Regions of the proximal femur Inter -troch Troch Neck Forget the Ward’s triangle 9/21/2018 OSTEOPOROSIS

WHO Criteria For Osteoporosis based on comparisons to the Young Adult Mean BMD Normal < 1 SD below mean Osteopenia (low bone mass) 1 SD < BMD < 2.5 below Osteoporosis > 2.5 SD below ‘Severe’ Osteoporosis > 2.5 SD below and fragility fractures T - score Kanis et al. JBMR 1994; 9:1137-41 9/21/2018 OSTEOPOROSIS

high-resolution image accurate determination Instant Vertebral Assessment IVA generates a high-resolution image of the entire lateral spine in just 10 seconds, enabling physicians to visually assess vertebral status for a more accurate determination of fracture risk than just BMD alone 9/21/2018 OSTEOPOROSIS