You can learn if you have osteoporosis by having a simple test that measures bone mineral density - sometimes called BMD. BMD - the amount of bone you have in a given area - is measured at different parts of your body. Often the measurements are at your spine and your hip, including a part of the hip called the femoral neck, at the top of the thigh bone (femur). Dual energy X-ray absorptiometry (referred to as DXA and pronounced “dex-uh”) is the best current test to measure BMD.
The test is quick and painless. It is similar to an X-ray, but uses much less radiation. Even so, pregnant women should not have this test, to avoid any risk of harming the fetus.
DXA test results are scored compared with the BMD of young, healthy people. This information results in a measure called a T-score. The scoring is as follows:
DXA T-score
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Bone mineral density (BMD)
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Not lower than –1.0
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Normal
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Between –1.0 and –2.5
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Osteopenia (mild BMD loss)
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–2.5 or lower
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Osteoporosis
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The risk of fracture most often is lower in people with osteopenia than those with OP. But, if bone loss continues, the risk of fracture increases. Yet, people taking glucocorticoids seem to be at an increased risk of fracture at higher bone densities than would be expected.
How is glucocorticoid-induced osteoporosis treated?
As doctors who are experts in diagnosing and treating diseases of the joints, muscles and bones, rheumatologists can help find the cause of osteoporosis. They can provide and monitor the best treatments for this condition.
Anyone taking glucocorticoid medicine must get enough calcium and vitamin D. The American College of Rheumatology recommends you should take at least 1,200 mg of calcium and 800 to 1,000 International Units (called IU) of vitamin D supplements each day. Your doctor may measure the vitamin D level in your blood to find out if you need more vitamin D supplementation.
Some people also will need medication. The decision to start prescription medications will depend on your other risk factors, the dose of glucocorticoid medication you are taking and how long you may be on it, as well as your BMD results by DXA.
The US Food and Drug Administration (better known as the FDA) has approved certain drugs to prevent and treat glucocorticoid-induced osteoporosis. In a drug class called bisphosphonates, alendronate (Fosamax), risedronate (Actonel), and zoledronic acid (Reclast) are FDA approved for both the prevention and treatment of glucocorticoid-induced osteoporosis.
Teriparatide (Forteo), a different type of drug, also is approved for treatment of glucocorticoid-induced osteoporosis. This manmade form of parathyroid hormone helps stimulate bone formation.
Women planning a pregnancy should talk to their doctor about the pros and cons of using a bisphosphonate or teriparatide. None of the prescription drugs for managing osteoporosis has enough safety data available to recommend using them in women who are pregnant or breastfeeding.