How can the clinician confirm a diagnosis of osteoporosis?
Densitometry testing alone will not always help. A history of fragility fracture is the most reliable predictor of the risk of future fracture, and can be used to make a diagnosis of osteoporosis. Clinical assessment here is more important than the patient’s T-score. We do not know the patient’s peak bone density, so one cannot tell if this hip T-score/ Z-score score is different from her baseline (after steroids) or preexisting (before steroids). If the loss is acute, it is more likely to result in perforation of trabecular structures and fragility that is out of proportion to the bone density. The patient is treated for osteoporosis with a bisphosphonate. Her bone density increases over the years and no further fractures are noted. A diagnosis of osteoporosis can be made in the presence of a fragility fracture despite the presence of normal BMD in this instance.
