How to diagnose the presence of osteoporosis and assess the risk of fracture

The approach to the diagnosis of osteoporosis has undergone a radical change in recent years. Osteoporosis is defined as a state of microarchitectural deterioration of the skeleton predisposing that skeleton to fragility fracture. In this sense it is a risk factor for disease in the same way as hypertension is a risk factor. Previously it was considered that bone density measurements using X-ray technology was the best non-invasive method of measuring the microarchitectural deterioration which thus came to define the disease. With the advent of new technology and a more logical approach to risk evaluation this simple approach is no longer appropriate. This chapter takes a stepwise approach to assessing the likelihood of osteoporosis on the basis of clinical factors and then suggests a method of integrating this information with a bone density measure to achieve a prediction of future fracture probability. Methods of diagnosing the cause of the osteoporosis are also outlined. Finally, application of these techniques in clinical care is discussed.