Can my clinician tell if I have osteoporosis during my annual checkup

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It is very important that your clinician take a good history during your annual check-up. The history is particularly important because osteoporosis is not painful unless you break a bone. Your clinician should ask you about the following:

  • Family history of osteoporosis
  • Personal history of fractures
  • Presence of chronic or new acute back pain
  • Menstrual history including menopause (surgical or natural); amenorrhea
  • Medications that can cause secondary osteoporosis (see Question 16)
  • History of illnesses that are associated with secondary osteoporosis (see Question 17)
  • Lifestyle factors such as cigarette smoking, heavy alcohol consumption, and activity level
  • Intake of calcium and Vitamin D.

After taking a thorough history, your clinician will examine you. For the purposes of detecting osteoporosis or for conditions that put you at increased risk of developing osteoporosis, your clinician should pay particular attention to the following:

  • Height loss
  • Low body weight on petite frame, BMI <22; or BMI >28
  • Elevated pulse and blood pressure (for overproduction of thyroid hormone)
  • Tooth loss
  • Enlarged thyroid gland
  • Tenderness over bones of your back
  • Curvature of the spine (kyphosis)
  • Limited range of motion in the spine, shoulders, elbows, wrists, hips, knees, or ankles
  • Shortened distance from the rib cage to the front edge of the pelvis while lying down face up (happens when spine begins to curve from repeated fractures)
  • In men—smaller testicles may indicate loss of testosterone (related to hypogonadism)
  • In women—breast and pelvic exams may show evidence of estrogen loss.

Even after collecting all of this information, your clinician cannot determine if you have osteoporosis. They use this information to determine your risk for osteoporosis and then will order testing if needed (see Question 24).

Penny's comment:

Since age 65, I have had a complete yearly physical, blood work, urinalysis, and so forth. When I reached age 79, my doctor thought it would be a good idea to have a bone density test. My left hip showed the beginnings of bone loss, but only to the degree of "osteopenia.." I then started taking 1,200 milligrams ofcalcium, plus Vitamin D.

At this year's exam, my doctor noted it had been 3 years since my last bone density test. I was sent to a bone specialist's office for the tests. I had a scan of my ulna and radius. After that I was led into another room for a spinal x-ray because I had a compression fracture a little more than a year ago in the thoracic region of the spine. My hip was also tested.

Lying on that white x-ray table was an ordeal I would not like to face again. Not only was the room cold, but also the hard smooth surface of the table was like ice, and maneuvering me into the position they desired was very painful. I do have the beginnings as well of arthritis, and some of the movement, not noticeable on standing and normal movement, caused a great amount of discomfort.

After the tests were done and the results printed out, I was given a stack of papers to look at, and they were compared against the bone structures of some unknown 30-year old to give me a score that assured me of the diagnosis. After all the tests, I was diagnosed with the real thing—osteoporosis.

It was a shock to me. Two years ago, my orthopedic doctor told me at the time I was put in the brace for the compression fracture in my back that this might happen again and to keep the brace handy. He also mentioned that there were some signs of arthritis at the time. But he never actually told me that I had osteoporosis.

When you reach age 82 plus, you expect some aches and pains and creaking joints and a feeling of malaise once in a while, but you never put a name to it because the next day it can be better.

Now that I have been told unequivocally that I have osteoporosis, I feel mentally stooped inside. From what I can tell by looking in the mirror, though, my spine is not nearly as curved as those on the diagrams hanging on all four walls in the osteoporosis specialist's office.

I was told I had a choice of three medications to keep the deterioration of the bone to a minimum. I chose weekly Actonel. I have to be cautious and take it exactly as directed so that I dont get more stomach upset than I already have. I was also told to take an extra 400 mg of Vitamin D once a day to insure a better response to the 1200 mg of calcium I am also taking. The calcium levels in my blood are normal. The specialist also wanted me to exercise. I told her that lifting art supplies for my painting class, walking up and down the aisles of the grocery store every day, and doing my leg exercises at home would have to be enough exercise.

I can laugh, and groan, and complain about how growing old takes courage. I just hope that between now and the time I return to the doctor, I will have regained my sense of humor, and be grateful the sun is still shining and that I am NOT walking with a cane, a walker, or sitting slumped in a wheelchair.

23. My clinician is concerned about my loss of height of one inch in the past year. Does that mean I definitely have osteoporosis?

Once you reach midlife, you should be measured for height each year that you go for an annual check-up. In addition to height, your spine should be assessed for kyphosis (prominent upper curve of the spine giving a hunched over appearance). Although loss of height can mean other things such as poor posture, decreased muscle strength, or even poor measuring techniques, it can be a good indicator of bone loss in the spine.

In fact, in one study, 75% of new vertebral fractures were found in individuals who had lost one to two inches in height.

Tiny compression fractures of the vertebrae can happen silently (without pain), reducing your height and causing the spine to curve. Figure 6 (Question 19) shows the progression from a normal spine to the curved spine, causing a loss of height. Your clinician is right to be concerned, and you should be further evaluated for osteoporosis.

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