How will my clinician use my test results to determine whether I have osteoporosis

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A T-score, expressed in standard deviations, will be reported to your clinician, and your score will most likely be evaluated using the WHO guidelines. Most machines are calibrated with special software to determine your scores. Based on the guidelines (see Question 32), your results will indicate normal bone density, low bone mass (osteopenia), or osteoporosis. If you have osteoporosis with a fragility fracture, you will have a diagnosis of severe osteoporosis. Because the T-score not only reflects bone density but also your risk of fracturing a bone, your clinician should discuss specific ways of not only increasing your bone mass but also lowering your fracture risk (see Question 79).

A Z-score is usually not helpful in making the diagnosis of osteoporosis. However, if it is particularly low (lower than -1.5), it is important for your clinician to evaluate you for conditions and illnesses that may be causing your bone loss associated with secondary osteoporosis. Such causes of secondary osteoporosis might include thyroid or parathyroid disease, cigarette smoking, excessive alcohol intake, problems with absorption from your gastrointestinal tract, or the use of medications known to be harmful to bone.

If you had a peripheral bone density test (at the wrist or heel), you may still require central testing (at the hip or spine) even if your test results are interpreted to be in the normal range, unless you weigh over 250 pounds and a central test cannot accommodate you. The following individuals should have BMD testing of their hip and spine, even if tests of their wrists or heels are normal:

Postmenopausal women who are not on menopause hormone therapy (MHT) who are concerned about osteoporosis and concerned about prevention, and who would consider MHT or other treatments for low bone mass, if discovered by central testing

• Maternal history of hip fracture

• Cigarette smoking

• Tallness (>5'7") or thinness (<125 pounds)

• Patients on medications that are known to contribute to bone loss

• Patients with secondary conditions associated with low bone mass (for example, hyperthyroidism, malabsorption, hyperparathyroidism, alcoholism)

• Patients found to have high urinary collagen crosslinks (see Question 40)

• Patients with a history of fragility fracture.

It's important to remember that even if your T-score fits into the category of normal, you may still have osteoporosis at another site. Even though central bones measured on a DXA are the most predictive for the rest of your body, other sites can still have lower mass. Peripheral measurements (heel, wrist) are not as predictive for the rest of your body. So, even if you have normal measures of your heel or wrist, your clinician may send you for additional testing with different machines or on other bones, especially if you have many risk factors or a fracture. If you have a frailty fracture or a low-trauma fracture (see Question 74), you likely have osteoporosis whether you are tested for it or not, although it's important to get a baseline

It's important to remember that even if your T-score fits into the category of normal, you may still have osteoporosis at another site.

measurement so that the effectiveness of treatment can be evaluated by your clinician.

If you are diagnosed with primary osteoporosis (post-menopausal, age-related), the American Association of Clinical Endocrinologists (AACE) recommends that you also have a complete blood count (CBC) and other blood tests for minerals such as calcium and phosphorus, liver function, kidney function, and electrolytes such as salt and potassium. These additional tests will help rule out other causes for your low bone density.

While you may be told that you have osteopenia based on your T-score, a T-score between -1.0 and -2.5 does not necessarily mean that bone loss has occurred. It could mean that you never reached peak bone mass in young adulthood to begin with. If you have osteopenia, your clinician likely will evaluate you for causes of secondary osteoporosis (see Questions 10 and 33). Treatment is usually indicated to prevent osteoporosis, whether the osteopenia is due to some bone loss or a low peak bone mass (Part Three discusses treatment options).

Talking about how and when you will be informed of the results will eliminate confusion.

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