Biochemical blood test algorithm for osteoporosis. How is osteoporosis diagnosed? What tests are needed? About diagnostic measures

This often includes:

  • Drinking alcohol, smoking
  • Not proper nutrition
  • Lack of physical activity, sedentary lifestyle
  • Use of medications(glucocorticosteroids, anticoagulants, antiepileptic drugs, hormones, cytostatics).
  • Concomitant pathologies(rheumatological diseases, gastrointestinal diseases, renal and liver failure)
  • Hormonal changes(menopause at an early age up to 40 years, hypothyroidism, hyperthyroidism, hypercortisolism, adrenal adenoma, diffuse goiter, etc.)

Currently the safest and most simple ways diagnosis of osteoporosis. They often examine the bones that are most susceptible to fracture: the arms, hips, and vertebrae. Diagnostics helps determine the overall picture of osteoporosis, bone structure, and the risk of sudden fractures. Diagnosis of osteoporosis has important for life and a patient with an existing disease.

Methods for diagnosing osteoporosis

TO methods for diagnosing osteoporosis can be attributed:

  • X-ray
  • Bone
  • Ultrasound sonography
  • Laboratory diagnostics (determination of osteoporosis markers)
  • Genetic research
  • Additional invasive methods

X-ray for osteoporosis

In Russia, the most used diagnostic method is still radiography of different areas of the skeleton. However, radiography for osteoporosis cannot be carried out frequently for preventive purposes due to harmful ionizing effects on the body. As a rule, osteoporosis is discovered accidentally when a person with a fracture comes to the trauma department. Osteoporosis is divided into moderate and severe (according to diagnostic criteria).

Mild osteoporosis is caused by low bone mineral density and is diagnosed in the presence of a transparent shadow and striations bone tissue in the picture. Moderate osteoporosis is already associated with a more significant decrease in bone density, which is characterized by convexity of the vertebrae or their wedge-shaped changes. Severe osteoporosis increases the transparency of bone tissue on photographs. In this case, it may be noted wedge-shaped deformity of the vertebrae.

Using radiography, osteoporosis can be diagnosed when there is a loss of 25-30% of the total bone mass. Also, in the radiographic diagnosis of osteoporosis, the qualifications of the radiologist are important.

Bone densitometry

Differences bone densitometry from x-rays for osteoporosis are that densitometry has a lower radiation dose and high diagnostic efficiency. For more precise definition bone density, various medical equipment is used for bone densitometry. A more correct name for this diagnostic method is Single-energy X-ray absorptiometry.

This method of diagnosing osteoporosis helps to identify the disease at an early stage already with 2-3% loss of bone mass. In addition, densitometry allows you to analyze the dynamics of osteoporosis and evaluate the effectiveness of treatment.

IN medical practice There are enough ultrasound and radiological methods for diagnosing and determining bone mineral density(BMD). Despite all the advantages of such methods for diagnosing osteoporosis, not every method demonstrates high accuracy and efficiency.

The most common diagnostic method that is often used to determine osteoporosis is the bone mineral density test. Dual-energy X-ray absorptiometry (DXA, DEXA). This diagnostic method helps determine the level of minerals in all areas of the skeleton. In addition, DXA helps reveal the ratio of muscle to fat mass throughout the body. BMD results are compared with normal DXA values ​​typical for women aged 25 years. Equipment for densitometry as a result of the examination issues T-score And Z-score.

The T-score indicates the severity of osteoporosis, the Z-score, in turn, indicates deviations in bone density relative to the patient’s age. The norms of T- and Z-indicators are equal to the value “1”. The Z-score provides additional information and, as a rule, it confirms the diagnosis.

Densitometry values, in particular bone density, may deviate significantly from the norm in the range T = -1 to -2.5, which indicates that the patient has osteopenia(reduced bone density). With more significant deviations, osteoporosis is already diagnosed (for example, a T value less than -2.5 has been detected).

The main way to measure bone mineral density is dual-energy x-ray absorption and laser scanning (DXL), which facilitates diagnosis and provides very accurate data during examination. Laser scanning of bones helps determine their thickness and volume. Bone density in this method is examined at the heel, which consists of trabeculae. The laser measurement accuracy can reach 99%.

Measuring BMD in osteoporosis helps to identify pathology at the initial stage. Bone mineral density can also be used to reduce the risk of fractures. Laser densitometry allows you to analyze the rate of bone demineralization over last year Therefore, this method of diagnosing osteoporosis can probably be used to evaluate the effectiveness of treatment. Laser diagnostics helps to more accurately determine the presence of osteoporosis at the initial stage.

Ultrasound sonography

Today, in the medical diagnosis of osteoporosis, methods are used ultrasound sonography, allowing you to determine other indicators of bone structure. These indicators of ultrasound sonography are: SOS– ultrasound speed through bones, BUA– wave scattering of ultrasound in the measured area of ​​the skeleton. Their results, according to many experts, are suitable for identifying bone strength.

At the moment, doctors say that ultrasound densitometry is an excellent method for diagnosing osteoporosis for the prevention of fractures. In the near future we can expect that more modern and simpler equipment for ultrasonic densitometry will be developed.

Bone densitometry helps identify key indicators of bone strength. This diagnostic method helps in determining BMD and the rate of its loss up to each percent. With the help of densitometry, it becomes possible not only to assess the effectiveness of treatment, but also to quickly make a diagnosis. It has been noted that such diagnostic methods do not provide accurate information about the metabolic processes occurring in the bones. To do this, it is necessary to use biochemical blood parameters, the interpretation of which will help in determining the rate of bone growth and resorption.

One of the biochemical markers of osteoporosis is the concentration osteocalcin in the blood. In addition, markers of bone resorption also include the level deoxypyridinoline.

Exceeding the normal values ​​of the bone matrix may indicate the presence of osteoporosis, disruption of the processes of bone tissue formation, osteodystrophy, kidney diseases.

Norms of bone matrix formation marker– from 8 to 94 ng/ml.

Serum protein electrophoresis

Serum protein electrophoresis– separation of proteins in the blood into fractions using an electric field. Blood proteins consist of albumins and globulins of several types. Their deviations from the norm may indicate the presence myeloma, metastases, as well as in severe or initial stages of osteoporosis.

Parathyroid hormone (PTH)

Parathyroid hormone (PTH) in the human body participates in the regulation of bone tissue restoration processes. Parathyroid hormone, as the name suggests, is produced by the parathyroid glands.

Changes in PTH levels indicate a high risk of fractures and imbalance calcium and phosphorus.

Postmenopausal osteoporosis may not show any abnormalities in tests when determining PTH levels. Senile or senile Osteoporosis, on the contrary, will be associated with a high concentration of parathyroid hormone.

Parathyroid hormone levels(on average) – from 4.8 to 110 pg/ml in both sexes.

Calcium in the blood in osteoporosis

Calcium is one of the building materials bone tissue. Analysis on calcium in the blood for osteoporosis necessary to determine hypercalcemia.

Laboratory testing for primary osteoporosis may show normal calcium levels. An increased level of the mineral in the blood is likely in senile osteoporosis, as well as in long-term treatment while on bed rest due to a hip fracture.

Calcium level in blood: from 2.15 to 2.5 mmol\l

Phosphorus for osteoporosis

Phosphorus – regulates bone density and calcium levels in them. Definition phosphorus for osteoporosis in the blood is necessary if there is a high risk of osteomalacia.

Phosphorus can often be within normal limits in primary osteoporosis. In old age, phosphorus levels are usually reduced. Low phosphorus levels are often associated with osteomalacia.

Norms of phosphorus in the body– from 0.8 to 1.4 mmol/l.

Blood test for vitaminD

In the body it regulates metabolic processes involving calcium. Blood test forD necessary if the patient has disorders associated with a deficiency of this substance.

Vitamin standardsD– from 70 to 250 nmol/l.

Estrogens (female sex hormones) regulate the growth of bone cells and directly contribute to an increase in their density.

Determining the level of estrogen in a woman’s blood is necessary if, in addition to signs of osteoporosis, there are also primary symptoms of menopause.

Estrogen levels in women– from 65 to 1600 pmol/l.

In the postmenopausal period, estrogen levels are significantly reduced - up to 75 pmol/l.

Androgens (testosterone)

Androgens (testosterone) in the male body they are responsible for the growth of osteocytes and have a direct effect on bone mineral density.

At the first signs of osteoporosis in men, the first step is to take a test to determine testosterone levels.

Testosterone levels in men– from 6.5 to 42 nmol/l.

Analysis for somatomedin-C

Somatomedin-C (insulin-like growth factor-1, IGF-1) is a hormone responsible for the growth of bone cells. Analysis for somatomedin-C It is also recommended to take it if you suspect osteoporosis.

Norms of somatomedin-S– men under 55 years old – from 0 to 5 µg/l., women under 55 years old – from 0 to 18 µg/l.; men over 55 years old – from 1 to 10 µg/l, women after 55 years – from 1 to 15 µg/l.

Blood insulin levels

Insulin is a pancreatic hormone that, in addition to glucose metabolism, is also involved in the construction of bone tissue. Normalblood insulin levels from 3 to 19 µU/ml.

Blood test for thyroxine

Thyroxine (L-thyroxine, T4 hormone) is a thyroid hormone that has a stimulating effect on the activity of osteoclasts. High level thyroxine leads to bone destruction. Change blood test for thyroxine necessary to confirm the diagnosis

Thyroxine norms– from 10 to 19 pmol/l.

Corticosteroid hormones (cortisol, aldosterone)

To the main corticosteroid hormones can be attributed cortisol– a stress hormone for mobilizing all the body’s resources under stress and aldosterone– a hormone responsible for the regulation of fluid in the body and the rate of excretion of minerals.

Both of these hormones delay the production collagen(protein) found in bones. Low collagen levels leads to osteoporosis.

If necessary, the level of cortisol is additionally determined in the urine.

Blood cortisol levels: from 130 to 660 nmol/l.

Norm of cortisol in urine: from 29 to 210 mcg per day.

Aldosterone norm: in men – 25-370 pg/ml, in women – from 15 to 150 pg/ml.

C-terminal telopeptides of collagen (Beta-CrossLaps)

C-terminal telopeptides of collagen are one of the markers of bone resorption. Knowing the value of this indicator, it becomes possible to determine the rate of resorption of “old” osteocytes.

In the laboratory diagnosis of osteoporosis, this indicator is necessary to determine the effectiveness of treatment for diseases of the skeletal system.

Standards for this indicator– in men under 20 years old – 0 ng\ml, from 20 to 30 years old – 150-870 ng\ml, from 30 to 60 years old – 94-640 ng\ml., men over 60 years old – from 30 to 825 ng\ml ml.

In women, C-terminal telopeptides of collagen are found only in premenopausal And postmenopausal periods. Norms at the same time they range from 28 to 1000 ng/ml.

This type of laboratory diagnosis can also be used to determine impending menopause.

Bone TRAСP 5b (tartrate-resistant acid phosphatase)

Bone TRAСP 5b– another marker of bone resorption, indicating the rate of osteoporosis development and osteoclast function. The marker also helps to determine the severity osteopenia and the presence of bone cancer, since this enzyme is tumor marker. Normtartrate-resistant acid phosphatase: for women – from 1.1 to 4.2 units/ml., for men – from 1.4 to 4.6 units/ml.

Deoxypyridinoline (DPID) and hydroxyproline

Deoxypyridinoline (DPID)– a material in bone tissue that binds collagen. If it is detected in the urine, the diagnosis of osteoporosis can already be confirmed. Oxyproline is the predecessor deoxypyridinoline and can also be found in urine. A large amount of oxyproline and deoxypyridinoline in the analysis indicates pathology. The level of deoxypyridinoline is determined based on the ratio with creatinine.

Norms of deoxypyridinoline: in men – from 2.5 to 5.5 nmol/mmol of creatinine, in women – from 3 to 7.3 nmol/mmol.

Human genetic predisposition to osteoporosis. The latest methods of laboratory diagnosis of osteoporosis

Modern laboratory research studying genetic predisposition of a person to osteoporosis, are at the experimental stage and therefore rarely used in medical practice. Determination of genetic markers is possible only in special medical institutions with expensive equipment. In the process of laboratory diagnostics, specialists determine all hereditary factors that influence the occurrence of osteoporosis. In addition, hereditary markers of osteoporosis may prevent disease long before the appearance of the first clinical symptoms.

Among the genetic markers, two genes and all changes in them can be distinguished.

Col1 A1 – responsible for the production of collagen in bone tissue. Even the slightest changes in DNA lead to destabilization of collagen structure(the bones will contain an extremely small amount of the protein responsible for the growth and division of bone cells).

GeneVDR3 – a section of DNA in cells that is responsible for the growth of vitamin D3 receptors. Suppression of the activity of this area leads to the fact that the normal amount of vitamin D3 and, accordingly, calcium will not be absorbed by the body. A deficiency of these two substances is the cause of the development of hereditary osteoporosis.

Additional invasive methods for diagnosing osteoporosis. Differential diagnosis of osteoporosis

Iliac bone biopsy

Iliac bone biopsy carried out for differential diagnosis of osteoporosis, myeloma, as well as in the presence of metastases. During a biopsy, a specialist removes bone tissue from the sacroiliac bone for further histological analysis.

This procedure is not considered a primary diagnostic method and is used in some cases.

Sternal bone marrow puncture

Sternal puncture involves removing the latter from the sternum using a special needle for further examination. Previously, this diagnostic method was often used for osteoporosis. At the moment, this method is rarely used, especially with severe osteoporosis, as it increases the likelihood sternum fracture during a puncture by a doctor.

Conclusions on osteoporosis and methods of its diagnosis

All of the above examination methods relate to accurate and important ways diagnosis of osteoporosis. In order to prevent further fractures, it should be carried out in risk groups.

Risk factors include: menopause in women at an early age (up to 40 years), absence of menstruation, low levels of sex hormones, simultaneous treatment with corticosteroid drugs, hyperthyroidism, intestinal diseases, cachexia, chronic renal and liver failure.

The main symptoms of the disease are changes in bone density on x-ray, frequent changes, and short stature.

After identifying the main symptoms and risk factors, you need to create a treatment plan for osteoporosis V medical center under the guidance of a qualified physician.

During the examination, it is also worth considering the need for differential diagnosis when studying x-rays. In older patients it is necessary to exclude metastasis bones. Determining possible metastases is of paramount importance, since they appear in the same place where osteoporosis is usually localized. In order to determine the diagnosis, laboratory diagnostics are carried out, and bone puncture is often performed.

Osteoporosis is an extremely common disease characterized by decreased bone density. To a certain extent, the increasing frequency of diagnosed cases of osteoporosis is explained not so much by the deterioration of the health of the population, but by an increase in life expectancy (the disease mainly affects people in the older age group).

The development of the diagnostic capabilities of modern medicine has played a certain role in the increase in the number of patients with increased bone fragility. The most informative method for diagnosing osteoporosis is bone densitometry, which allows not only to determine the percentage of bone loss, but also to identify structural disorders of bone architecture.

The mechanism of development of bone tissue pathology

Bone is a highly specific tissue that contains three structural elements:

  • protein matrix that makes up the main connective tissue, which retains minerals in the bone;
  • mineral component consisting of calcium and phosphorus;
  • bone cells responsible for the reconstruction of bone tissue.

Contrary to popular belief, bone does not have a permanent, once formed structure. In essence, it is a living structure whose main purpose is to ensure optimal maintenance human body. During life, the nature of the loads on the load-bearing apparatus of the human body changes repeatedly; the reasons for the changes can be:

  • weight gain;
  • lifestyle changes (increasing or decreasing mobility);
  • increase in external loads (systematic lifting of weights), etc.

The influence of these factors forces the bone to constantly carry out internal restructuring, allowing it to maintain stability and maximally resist changing loads. In this case, bone tissue is destroyed in a place that does not require increased strength, and harder tissue is formed in the most “loaded” area. The remodeling process is constant, and bone cells are responsible for it - osteoblasts, which form a new matrix and osteoclasts, which destroy it.

Regular physical activity stimulate metabolic processes in the bone structure

The age period up to 20-30 years is characterized by a high rate of metabolic processes, in which bone formation occurs under the influence of various factors (strength loads, amount of calcium consumed, hormonal changes). Once maximum bone mass is reached, the processes of loss and restoration are balanced. The main cause of osteoporosis is the predominance of resorption (destruction) processes over formation processes.

Important! If in young people the rate of metabolic processes in bones is 50% during the year, then in the age category over 50 years old it is no more than 5%, while resorption processes inevitably prevail over formation processes.

Indications

Since loss of bone mineral density (BMD) is always a consequence of some disease or condition, there are certain categories of people who are indicated for screening for osteoporosis.

So, the indications for the examination are:

  • age over 45 for women and over 55 for men;
  • postmenopausal women;
  • endocrine disorders ( diabetes mellitus, dysfunction of the thyroid gland);
  • multiple pregnancies (more than 3) or prolonged breastfeeding;
  • several cases of bone fractures within 3–5 years;
  • patients taking drugs from the corticosteroid group, as well as tranquilizers and anticonvulsants;
  • maintaining a sedentary lifestyle (long-term bed rest, use of a wheelchair);
  • sudden weight loss or constant low weight;
  • presence of relatives diagnosed with osteoporosis.

Important! Insufficient intake of vitamin D in the body can cause the development of osteoporosis. Smoking and drinking alcohol are one of the causes of osteoporosis.

Diagnostics

Among the list of tests for osteoporosis, densitometry rightfully occupies a leading place, as it allows for a quantitative assessment of the condition of bone tissue. A urine test for the amount of excreted calcium and hydroxyproline, which in patients with progressive osteoporosis are usually excreted in the urine to a greater extent than absorbed by the body, has a certain informative value, applicable to assessing the intensity of bone destruction.

In addition, the initial examination includes testing the urine for deoxypyridonoline (DPID), which is excreted unchanged (unbound) in the urine as a result of slow or absent metabolic processes in bone tissue.

Since the main goal of diagnosing osteoporosis is to identify a category of patients prone to decreased bone mass, it is advisable to carry out a comprehensive assessment of osteoblast activity, determined by the amount of osteocalcin per day, parathyroid hormone, alkaline phosphatase and deoxypyridonoline.

Table . Normal values ​​of biochemical markers

Determining the concentration of female and male sex hormones has a fairly high diagnostic value, since it is endocrine disorders that often become the cause of the development of osteoporosis.

X-ray densitometry

The most commonly used method for examining bones for osteoporosis is densitometry. The term “densitometry” combines several methods of obtaining images that allow a quantitative assessment of the bone mineral density (BMD) of the patient being examined. Certain results in assessing BMD have been achieved using conventional x-rays.

However, it is not possible to obtain any significant quantitative results with its help. The determining factor that excluded radiography from the list of methods used to diagnose osteoporosis was the fact that even when assessing the image by an experienced doctor, it was not possible to detect bone loss of less than 40%.

Carrying out a dynamic assessment of the progression or regression of the disease is also quite difficult due to the low sensitivity of the equipment. Despite this, radiography is successfully used when it is necessary to assess the degree of deformation of bone structures, for example, vertebrae, since a similar phenomenon often occurs with the development of osteoporosis.

Important! It is advisable to study the degree of changes in BMD in areas of the skeleton where the proportion of trabecular tissue predominates (femoral neck, lumbar region spine, wrist joint), since osteopenic changes affect it first.


Minor bone loss cannot be diagnosed using an x-ray.

Most popular methods x-ray examination The IPC is considered to be:

  • dual-energy x-ray absorptiometry (DEXA);
  • morphometric X-ray absorptiometry (MRA);
  • quantitative computed tomography(KKT).

All x-ray methods for studying the degree of BMD reduction are based on the movement of ionizing radiation from a source located outside through the bone to a fixing detector. In this case, a narrow beam of X-ray radiation is directed to the object under study and the final result, that is, the intensity of the radiation transmitted through the bone is recorded by a computer system.

The main principle of the DEXA method is the use of double radiation, which allows the error to be reduced as much as possible due to the registration of two options for energy absorption (in soft tissues and bones).

The MRA method is a variant of DEXA, however, the use of a fan-shaped radiation flux has improved image quality and reduced scanning time, and accordingly reduced the radiation dose to the patient.

The QCT method allows you to obtain a three-dimensional image and not only determine BMD, but also obtain data on the layer-by-layer structure of bones, that is, assess the condition of the trabecular and cortical layers. Negative side The use of CCT is a high radiation dose, exceeding DEXA by 10 times and the dependence of the accuracy of the readings on the amount of bone marrow, the percentage of which increases with age.

Ultrasound computer densitometry

The method of ultrasonic densitometric research is based on calculating the speed of movement of an ultrasonic wave through tissues of different densities. Differences in the density of the bone being examined cause differences in the speed of ultrasound transmission, that is, denser bone (well mineralized) transmits ultrasound faster than less dense bone.

The received data is recorded by the sensor and converted using computer software into quantitative indicators. A characteristic property of ultrasound densitometry is its extremely high sensitivity to the slightest changes in bone density. In this regard, it can be used to diagnose osteopenia, when the loss of mineral substances does not exceed 3–5%.

Undoubted advantages methods of ultrasonic computer densitometry can be considered:

  • sufficiently high information content;
  • no negative impact on the body;
  • speed of the procedure;
  • affordability;
  • no contraindications.

Thanks to such a large list of positive aspects, ultrasound densitometry can be used not only for diagnosing osteopenia and osteoporosis, but also for monitoring the effectiveness of therapy. Due to significant deviations that appear when examining bones deeply embedded in soft tissue (proximal femur), ultrasound densitometry is performed exclusively on the extremities (wrist joint, calcaneus, etc.).


Long bones are the most informative when performing ultrasonic densitometry

Conduct and results

The technique of X-ray densitometry consists of performing a set of measurements using radiographs at several standard points most susceptible to osteopenic changes:

  • lumbar spine;
  • femoral neck;
  • radius.

After taking a series of pictures, software carries out processing of the obtained results by comparison with the database embedded in it. The comparison is made according to two criteria:

  • the result obtained with the optimal indicator for patients of the same sex (T-criterion);
  • the result obtained with the average statistical indicator of patients of the same sex and age (Z-criterion).

The most informative when making a diagnosis is the T-criterion; checking the degree of its deviation from normal indicators has a significant diagnostic value:

  • readings above “-1” indicate normal BMD;
  • readings ranging from “-1” to “-2.5” indicate osteopenia (the initial stage of osteoporosis);
  • readings below “-2.5” indicate the development of osteoporosis.

Ultrasonic densitometry is carried out by determining the density of the cortical (outer) layer of tubular bones. To do this, using an ultrasound sensor, an ultrasonic wave is passed along the bone, determining the MIC by the speed of its propagation. In a short period of time, the device performs thousands of measurements and calculates Z and T-criteria based on the results. Standard projections for ultrasonic computer densitometry are:

  • phalanx of the middle finger;
  • radius or wrist bone.

Important! The results obtained using X-ray and ultrasound methods may have some differences, but the final indicators are usually interpreted the same (normal or osteoporosis).


Structural changes in bones: on the left – normal, on the right – osteoporosis

Due to the individual characteristics of the course of the disease, there may not be obvious signs of bone tissue destruction, such as fractures. However, timely diagnosis can significantly reduce the risk of such a serious complication as a femoral neck fracture.

Despite the fact that the pathology is not fatal, a long-term decrease motor activity and expensive treatment (prosthetics), which is also impossible to carry out in severe stages of osteoporosis, often lead to death.

Today, doctors have a large number of medicines, intended for the treatment of osteoporosis, but due to the fact that the recovery process is extremely long, it is optimal to start it as early as possible.

At the age of 45-60, a person increasingly pays attention to frequent pain in the back, lower back and spine. Pain occurs due to various reasons, but most often it is a sign of osteoporosis. What is it? This is a chronically progressive systemic metabolic disease, which is characterized by the inability of bone tissue to fully absorb calcium. The bones become thin, brittle, and any blow can lead to a fracture.

This disease often occurs in women during menopause. when the reproductive and menstrual functions of the body decrease. During this period, the endocrine system undergoes changes, as a result of which diseases such as osteoporosis and a number of others may appear.

The causes of this disease are:

  1. Not healthy image life. A person spends a lot of time sitting and moves little, which contributes to fat deposits in the body. Over the years, there are more and more of them, resulting in the appearance overweight, which falls with all its weight on the bones. This pressure can cause mechanical injury knee joint or bones.
  2. Poor nutrition. There are a number of products (for example, coffee and caffeine containing) that help slow down metabolism and remove calcium from the body. There are very few calcium-rich foods in our daily food, and the rhythm modern life involves the use large quantity caffeine, which together leads to bone destruction.
  3. Bad habits. Toxins such as alcohol and nicotine reduce the absorption of calcium by bone tissue and promote its excretion from the body. As a result, the bones become thinner and brittle.
  4. Endocrine diseases. The endocrine system provides the body with hormones necessary to regulate various processes. The parathyroid glands synthesize parathyroid hormone, which regulates calcium metabolism. Disruption of its functioning negatively affects the absorption of calcium by the body.

Osteoporosis occurs:

  1. External physical defects. For example, stoop or curvature of the spine. This is due to the fact that under heavy load (heavy bags and the like), the distance between the vertebrae decreases, and weak vertebrae become deformed. Also incorrect posture sets the position of the spine, which will be extremely difficult to correct due to a lack of calcium.
  2. Pain in the back and spine. The weaker the spine, the more difficult it is to carry heavy objects and perform various physical exercises.
  3. Long healing fractures. The basis of bones is calcium. It is calcium that “patches” any cracks or fractures in the bones, so its deficiency due to poor absorption can increase the time it takes to restore the integrity of bone tissue.

Slouching and pain in the back and spine often go away after a massage. If after one massage or a series of massage procedures a person’s pain goes away, if he can straighten his back, then this is a sign of normal fatigue. If the pain does not go away, then you should diagnose osteoporosis and consult a specialist.

What is the test for osteoporosis called? There are several types of checks: blood test, urine test and densitometry. Densitometry analysis for osteoporosis is a comprehensive assessment of bone tissue density using medical equipment. Testing for osteoporosis is carried out for the following indications: age (women over 45 years old, men over 60 years old), early menopause (including due to surgery), disorders of the parathyroid glands, taking drugs that reduce bone density (diuretics, anticonvulsants, contraceptives, etc.). However, it is recommended that everyone get tested for osteoporosis at least once a year.

What tests need to be taken?

  1. A blood test is done to determine the amount of calcium. Like any other analysis, it must be performed on an empty stomach, in the morning, and several rules must be followed so as not to spoil the results. The day before donating blood, it is necessary to exclude any physical activity and exclude alcohol and foods rich in calcium from the diet: milk, nuts, seaweed, legumes, coffee, dietary supplements that can reduce (in the case of coffee) or increase calcium levels in the blood. Half an hour before taking blood, you must be completely at rest. Tests for osteoporosis are done within one day. Its indicators are:
  1. total calcium – norm 2.2-2.65 mmol/l;
  2. inorganic phosphorus (85% of all phosphorus in the body is contained in the bones, participates in the formation of bone tissue) - the norm is 0.85-1.45 µmol/l;
  3. parathyroid hormone (synthesized by the parathyroid glands) – 0.7-5.6 pmol/l (9.5-75.0 pg/ml);
  4. osteocalcin (the main non-collagenous protein of bones, is involved in the process of bone tissue synthesis) – norm: for men 12.0-52.1 ng/ml; in women before menopause 6.5-42.3 ng/ml; for women during menopause 5.4-59.1 ng/ml;
  1. A urine test can determine the content of deoxypyridonoline (DPID), which is a marker of bone destruction. A urine test is performed according to the same rules as usual. Normal values ​​are: in men 2.3-5.4 nmol DPID/mol creatinine; in women 3.0-7.4 nmol DPID/mol creatinine.
  2. Densitometry allows you to determine the density of bone tissue in a specific area: the lower back, the upper part of the femur, the wrist joint and the entire skeleton.
  1. Ultrasound computer densitometry (echodensitometry) allows you to determine the density of bone tissue by the speed of passage of the ultrasound wave through the bone. The speed is higher when the wave passes through more mineralized tissue, that is, more dense. The duration of one study does not exceed 10 minutes, it is harmless to the body, and therefore more often used.
  2. X-ray densitometry is an examination of bones for osteoporosis, which allows you to clearly see the condition of bone tissue. This method is used extremely rarely; there are contraindications, since X-ray radiation has a negative effect on the body.

Where to get tested for osteoporosis does not matter, since each specialized clinic has necessary equipment for a full check.

Treatment and prevention of osteoporosis


It is impossible to completely stop osteoporosis, but its progression can be slowed down. For preventive purposes, women are prescribed estrogens in the first two years after menopause to prevent the disease. At the age of over 40 years, for the timely detection of osteoporosis, it is recommended to undergo densitometry every six months (rarely once a year), after which a strict diet that increases the calcium content in the body or calcium-based drugs is prescribed. The older a person is, the more calcium-rich foods he needs to take. For example, premenopausal women need 0.8-1 g of calcium per day, and postmenopausal women need 1.5 g per day.

The foods richest in calcium are:

  • skim milk (per 500 ml 1 g of calcium);
  • low-fat dairy products;
  • fresh, canned fish;
  • sunflower and sesame seeds;
  • nuts;
  • citrus;

In addition to the calcium diet, you need to do physical exercise. It is enough to walk, run or play tennis quickly. The main thing is that the training is regular (at least 30 minutes 3-4 times a week). Doctors advise that during the diet and subsequently also reduce and, if possible, stop drinking coffee and alcohol and smoking.

Prevention of osteoporosis does not guarantee that the disease will not occur, but it will slow down the process of its development. Unlike treatment, prevention is available to every person at any age. The preventive procedure has no contraindications and does not pose a health hazard, unlike treatment, the data on which are very contradictory.

Osteoporosis is a serious disease that results from improper functioning various systems in the body. It cannot be treated, since it is associated with age-related changes in the body, but a healthy lifestyle, proper nutrition, timely examination and consultation with a doctor can slow down the development of osteoporosis.

It is important to diagnose osteoporosis even before the appearance of external signs that indicate a severe form of the disease. This pathology is characterized by increased bone fragility due to calcium deficiency. To identify the disorder, it is necessary to take tests for osteoporosis, undergo an ultrasound and other additional studies of the body.

From women and, less commonly, men with suspected disease, blood is taken for biochemical and specific tests to identify signs of osteoporosis, urinalysis and densitometry are also performed. Additional diagnostic methods include genetic testing, MRI and CT densitometry.

Osteoporosis occurs due to a deficiency or impaired absorption of calcium in the body. The risk group includes women during menopause and men over 40 years of age. Long time the disease occurs without clinical manifestations, which complicates its detection. With osteoporosis, bone tissue is fragile, brittle and the risk of fracture increases even with mild injury.

More often, the disease is diagnosed in women at the onset of menopause.

Risk factors:

  • insufficient intake of vitamin D;
  • undergoing a course of hormonal therapy;
  • physical inactivity, sedentary lifestyle life and smoking;
  • pathologies of the adrenal glands and other glands internal secretion.

Main symptoms:

  • chronic fatigue;
  • spasms of the lower extremities;
  • plaque deposition on tooth enamel and periodontitis;
  • peeling of nails;
  • allergic manifestations;
  • dysfunction of the gastrointestinal tract.

You should consult a doctor if the following signs appear:

  • feeling of discomfort and pain in the area of ​​the shoulder blades;
  • curvature of the spinal column;
  • several cases of broken bones in a short period of time;
  • general weakness, change in height.

Blood test

A blood test is performed to assess calcium-phosphorus metabolism. This is the main method for diagnosing osteoporosis and will show whether there is a problem.

For this study, venous blood is collected. After this, the content of each substance is studied using various methods.

Preparing to donate blood:

  • a few days before the doctor stops some medications;
  • limit the consumption of fatty foods;
  • alcohol and smoking are excluded;
  • Blood is donated in the morning on an empty stomach.

Osteocalcin

The main collagen protein in bone is osteocalcin. Its determination is carried out using the RIA and ECLA methods. An increased protein content indicates initial development hyperthyroidism, osteodystrophy and postmenopausal osteoporosis. In a child, the substance is increased during the period of active development; in adults, it depends on gender.

Standard according to ECLA:

  • for men 18-30 years old - 22-70, for women - 10.8-42.5;
  • for men and women 30-50 years old - 13.5-43;
  • for men 50-70 years old - 15-47, for women - 14.5-47.

Inorganic phosphorus

The level of inorganic phosphorus depends on the remineralization process. Determined by colorimetry.

Elevated levels indicate excess vitamin D, acromegaly, bone breakdown and osteoporosis. A reduced content indicates possible rickets, hypercalcemia, lack of somatotropin, and metabolic failure.

Norm (mmol/l):

  • in children under two years old - 1.4-2.2;
  • from 2 to 12 years - 1.4-1.7;
  • up to 60 years - 0.8-1.3;
  • after 60 years - for women 0.9-1.3, for men 0.75-1.2.

Calcium

The level of calcium, the main component of bone, is determined by calorimetry.

Elevated levels indicate hypervitaminosis D, overdose of diuretics, and the development of hyperparathyroidism. A decrease in the norm is observed in childhood rickets, osteomalacia in adults, and hypoparathyroidism.

Norm (mmol/l):

  • in children under 2 years old - 1.9-2.6;
  • from 2 to 13 years - 2.2-2.7;
  • from 13 to 17 years old - 2.1-2.55;
  • from 17 to 60 years old - 2.5-2.6;
  • after 60 years - 2.05-2.55.

Marker D-Cross Laps

The marker shows the level of leaching of minerals. An increased rate is observed during menopause, hyperparathyroidism, arthritis, including rheumatoid form and osteopathy.

Norm (ng/l):

  • up to 49 years old - above 0.59;
  • up to 56 years old - above 0.58;
  • from 56 to 70 years - for men it is higher than 1.009, for women it is higher than 0.7;
  • after 70 years - above 0.8.

Alkaline phosphatase enzyme

High alkaline phosphatase activity indicates the occurrence of bone tissue diseases. The concentration is determined by the aminomethyl proponolone buffer method.

An increased content indicates osteomalacia, rickets, oncology, and the process of bone healing.

Norm (U/l):

  • from 3 to 7 years - above 644;
  • from 7 to 13 years - above 720;
  • from 13 to 18 years old - for girls from 448, for boys from 936;
  • after 18 years - above 105 for women, above 115 for men.

Genetic research

A comprehensive genetic study for osteoporosis includes the determination of collagen, collagenase, calcitonin, and vitamin D receptor. This study assesses the risk of developing pathology and the degree of susceptibility to fractures. Genetic analysis helps prevent the development of osteoporosis or prescribe the correct treatment, depending on individual characteristics.

The study shows a low, medium or high risk of osteoporosis. The study identifies gene mutations that can become or have already become the cause of the disease.

This is an expensive procedure that is carried out in special laboratories. It is not a mandatory research method and can be carried out at your own request.

Urinalysis

Urinalysis shows inorganic phosphorus and deoxypyridinoline (DPID).

The phosphorus norm is from 13 to 43 mmol/day.

An elevated level indicates an overdose of vitamin D, rickets, the formation of kidney stones, and limited mobility during a fracture. A reduced level indicates atrophic processes, bone metastases, acromegaly or an infectious focus in the body.

The normal DPID in the blood is 3.6-4 in women and 2.3-5.6 in men.

Preparation for the study is standard. Morning urine is collected. Alcohol, smoking and certain medications are avoided 48 hours before the procedure.

Ultrasound

Analysis is performed using ultrasound quality composition bone tissue. The study also identifies areas of compromised density. Most of all, the technique is suitable for preventive examinations every 3 years for timely detection of the disease during menopause and in men after 40 years.

During the scan, the doctor evaluates the elasticity, strength, and other mechanical properties of the bone. The method is not mandatory and does not provide comprehensive information about the causes, form and severity of osteoporosis.

Radiodensitometry

The gold standard for diagnosis is bone examination using bioenergetic absorptiometry or radiodensitometry. While scanning a separate area of ​​the skeleton, the device compares the reference value and the result obtained. This technique is used to examine the vertebrae, distal and proximal areas of the forearm and femoral neck.

The doctor receives two indicators - T and Z. The T value indicates a violation of tissue density in adults, Z indicates a deviation in a child.

Normally, the T indicator is 1. The disease is diagnosed when the indicator is from −1 to −2.5. If the value is even lower, this indicates a severe stage of osteoporosis.

The Z norm is also equal to 1. If there is a strong deviation in any direction, dystrophy and osteoporosis are suspected, therefore additional diagnostic methods are prescribed.

CT densitometry

The CT densitometry method provides a three-dimensional image of a specific area of ​​the skeleton. For this purpose, a peripheral scanner is used, which determines mineral composition. The method is indicated for studying a limited area of ​​bone tissue.

Preparing for the study:

  • stop taking calcium supplements the day before the procedure;
  • pregnancy is excluded;
  • the doctor finds out whether studies using contrast have been carried out.

To obtain a high-quality image, the patient must remain motionless during any diagnosis that involves scanning an organ.

MRI

Magnetic resonance imaging is rarely used to evaluate osteoporosis. An MRI examination is indicated to obtain a three-dimensional image and a comprehensive assessment of the condition of internal organs. Diagnostics shows high efficiency in determining the density of bone structure. After receiving the image, the specialist interprets it and sends the result to the attending physician for diagnosis.

No special preparation is required for the procedure. It is necessary to remove all metal jewelry and clothing items. You must remain motionless in the tomograph during the scan.

MRI has contraindications; scanning cannot be performed in case of metal implants in the body and in early period after surgery.

Prevention of osteoporosis

Measures for primary prevention of osteoporosis:

  • complete nutrition containing vitamin D, magnesium, calcium and phosphorus;
  • taking vitamin complexes and dietary supplements;
  • moderate physical activity.

Women during menopause should undergo regular examinations and blood tests. The same applies to men after 40 years of age. Considering that the disease can progress for several years without symptoms, its early diagnosis will help to begin treatment sooner to prevent complications.

Osteoporosis is a disease that is progressive and systemic in nature and is accompanied by a decrease in density with further changes in the structure of bone tissue.

Currently, the issue of diagnosing osteoporosis remains fully studied, so identifying this disease does not present any difficulties.


To diagnose osteoporosis, the patient is thoroughly examined

Generally high quality modern diagnostics osteoporosis is complex in nature and is based on an assessment of the patient’s complaints, examination data, as well as the results of laboratory and instrumental studies. The most informative and common methods for determining osteoporosis will be discussed in this article.

Before checking the condition of bones for osteoporosis using laboratory and instrumental methods, it is necessary to determine the factors that could influence the development of the pathological condition of bone tissue.

This can be done by carefully collecting anamnestic data, examining the patient and studying his outpatient card.

The most typical factors for the development of osteoporosis today are:

  • problems of the gastrointestinal tract, which are accompanied by impaired absorption of calcium;
  • vitamin D deficiency;
  • endocrine diseases;
  • low body mass ratio;
  • obesity;
  • sedentary lifestyle;
  • early menopause;
  • the presence of deformities of the spine and other bone elements;
  • insufficient amounts of calcium-containing products in the human diet;

    Read about what nutrition should be like for osteoporosis

  • long-term use of steroids;
  • long recovery period after bone injury.

To learn more about the various risk factors for the development of osteoporosis, as well as its main manifestations and stages, special materials will help, for example, the questionnaire “Osteoporosis in Women”, “Osteoporosis and Quality of Life”, “Osteoporosis and Pain Syndrome”.

Early diagnosis of osteoporosis is one of the ways to prevent the development of the disease. Read about other preventive measures

Methods for diagnosing osteoporosis

If a person has several risk factors for the development of osteoporosis and a history of bone fractures, the doctor will mandatory will offer such a patient to undergo examination to determine bone mineral density, called densitometry. Densitometry analysis for osteoporosis, the price of which depends entirely on the method of its implementation, is an assessment of bone density, that is, the coefficient of their saturation with calcium.

Currently, the most informative methods for diagnosing osteoporosis are considered to be:

  • ultrasound computer densitometry;
  • X-ray densitometry;
  • biochemical blood test for osteoporosis.

You will learn more about the densitometry method from the video:

Ultrasound computer densitometry

This is the most common method for diagnosing osteoporosis. The essence of the technique is based on determining the speed of passage of ultrasound through tissues with different densities: tissues with high density transmit ultrasound waves much faster than less dense structures.

The slower ultrasound passes through the bone, the lower its mineral density, and, consequently, the higher the degree of osteoporosis.

Ultrasound examination for osteoporosis is carried out using special, ultra-sensitive equipment. The doctor, moving the sensor in the projection areas of the bones affected by the pathological process, has the opportunity to display the obtained data on the monitor, as well as record them on digital media in order to study these results over time. The ultrasound densitometry method is very sensitive, which allows it to respond with maximum accuracy to the slightest changes in bone density indicators.

Such qualities make this method research is effective for diagnosis initial forms pathological process in the bones, when the loss of mineral density does not exceed 4% of the total.


Ultrasound computer densitometry is the most common method for diagnosing osteoporosis

Some of the most significant advantages of ultrasound densitometry include:

  • the absolute harmlessness of the method, when analysis for osteoporosis - densitometry using ultrasonic waves does not pose any threat to the health and normal functioning of the human body;
  • high information content of the study;
  • accessibility and relatively low cost of the technique;
  • speed of obtaining results: ultrasound densitometry allows you to determine indicators of osteoporosis within a few minutes from the start of the study;
  • no contraindications to the procedure;
  • painlessness of the method.

Ultrasound densitometry has no contraindications, therefore it is a universal method for determining bone tissue density, which can be used even in relation to people with severe pathologies, pregnant women and children.

The absolute indications for examining bones using ultrasound are:

  • age (for women it is 40 years, and for men it is 60);
  • the first signs of osteoporosis in women who have given birth many times or more than a year breastfed;
  • early or pathological menopause;
  • frequent fractures;
  • dysfunction of the parathyroid glands;
  • taking medications that remove calcium from bones.

X-ray densitometry

X-ray densitometry is a fairly accurate, but, unfortunately, not the safest method for determining bone density.
X-rays for osteoporosis allow you to examine such parts of the skeleton as the lower back, femoral neck, trochanteric region, wrist joint, and the like for this disease.

The study is a very effective and accurate method, but has a number of contraindications due to its ability to irradiate tissue.

That is why diagnosing osteoporosis in women in an interesting position, children, and seriously ill patients is impossible.

X-ray densitometry, being one of the first methods for studying the health of bone tissue, continues to be improved and developed in our time. This tendency to limit the harmful effects on the human body allows us to recommend this procedure to an increasing number of patients. What allows a doctor to see osteoporosis on an X-ray is the unique ability of X-rays to weaken when passing through bone structures, which makes it possible for a specialist to assess their surface mineral density.


X-ray densitometry is a very accurate method for diagnosing osteoporosis.

X-ray signs of osteoporosis are a reduced amount of minerals in relation to the total area of ​​bone tissue that the X-ray beam has passed through. The accuracy and accessibility, and most importantly the high information content of this procedure, made it an excellent alternative to the more expensive ultrasound densitometry.

Both methods have both their positive and, of course, negative sides.

Therefore, the question of the advisability of using one or another option for diagnosing osteoporosis in a patient should be decided exclusively by the attending physician.

This method consists of determining metabolic parameters in bones, such as best option additional examination of the patient.

Osteoporosis can be diagnosed not only by the results of instrumental studies. Laboratory diagnostics of osteoporosis will also help the doctor to predict the development of this disease, which is based on the quantitative determination of the levels of hormones of the endocrine glands (thyroid, parathyroid, reproductive) in the human blood, as well as the concentration of microelements that are responsible for the construction of bone tissue (calcium, magnesium, phosphorus) , in the patient's morning urine. These and other indicators in medical practice are called “markers of osteoporosis” and are significant factors that can confirm the presence of a pathological process and determine the nature of its origin.


Laboratory diagnostics of osteoporosis will help the doctor diagnose osteoporosis

What tests need to be taken for osteoporosis is decided by the attending physician, relying on the results of densitometric studies, the patient’s medical history, his complaints and the presence of clinical manifestations of the disease.

Biochemical diagnostics allows not only to identify the disease in the early stages of its development, but is also a very informative method of monitoring the effectiveness of the treatment, which allows us to assess its effectiveness or inappropriateness already after 8 weeks from the start of therapy.

When examining a patient with osteoporosis, the following laboratory tests are mandatory:

  • determination of thyroid hormone levels (TSH, T4);
  • blood test for sex hormones (for men – testosterone, for women – estrogens);
  • quantitative test for ionizing calcium;
  • determination of parathyroid hormone titers;
  • control of the level of active vitamin D (25-hydroxyvitamin D).

Other types and methods of determining osteoporosis

A method that allows you to identify foci of osteoporosis that remain undetected even with X-ray and tomography is scintigraphy. It is based on the use of technetium phosphate contrast. The ability of a contrast agent to penetrate bone tissue depends on the quality of metabolism and blood flow in the affected area.
For more information about the method, watch the video:

Areas with high blood supply and metabolism, which occur during fractures, metastases, infectious processes, hyperparathyroidism, appear on the scintiogram as “hot spots”.

In some cases, examination results need differential diagnosis, for example, to determine the true nature of the pathological process: the presence of hidden fractures, osteoporosis or metastases.

More information about what scintigraphy is, osteoporosis or metastases are visualized on a scintigram and what alternatives there are to this study can be better explained to the patient by his attending physician.

MRI examination is a highly technical, innovative and ultra-sensitive method for diagnosing the condition of internal organs and body systems, including determining bone density. The results of such an examination make it possible to evaluate morphological changes in tissues and monitor their functionality. MRI allows you to obtain a contrast image of internal organs in any plane without ionizing radiation or the introduction of chemicals. MRI is rarely used to determine bone mineral density. This is due to the high cost of the method and its tendency to overdiagnosis.


MRI is rarely used to diagnose osteoporosis.

It will help to assess the possible risks of developing bone osteoporosis. genetic research. A comprehensive genetic study allows us to determine disorders in genes that are responsible for the synthesis of vitamin D, collagen, the functionality of parathyroid hormone receptors and much more. Naturally, even if the method shows a person’s high tendency to develop osteoporosis, this is not yet a reason to get upset and start treatment immediately. Periodic prophylaxis will be sufficient to avoid future loss of bone density.

A comprehensive and complete examination allows us to determine the total diagnostic coefficient for osteoporosis. More comprehensive answers to questions about what an osteoporosis test is, what the most informative study is called, and where to go for help can be obtained from an experienced doctor. Don't delay in seeing a doctor!