I have taken you through physiological, pathological and the exercise therapy side of the bone story that has been running on this blog. Today I will tell you what are the methods you should use or atleast be aware of to detect and identify any osteoporotic signs in your bones.
Now osteoporosis can cause secondary problems and it also can be caused by other diseases or disorders already existing in your body that are asymptomatic or silent. So what you should look out for are obvious signs, signs that can't otherwise be communicated by your body if it were normal. Osteoporosis is primarily detected by dual energy x ray absorptiometry (DXA) or by single energy x ray absorptiometry (SXA), although DXA is more accurate. DXA tests show T - score and Z - score, you have to keep in mind the T- score as it is the determining factor in Bone Mineral Density. The normal bone mineral density T - score is - 2.5 a standard deviation of more than or equal to 2.5 from the normal is considered to be red signal for osteoporosis. DXA test is like the final frontier of sorts in the detection process as it clearly showcases the structure of the bone and its density. Before we arrive at DXA there are certain serological tests that need to be run to zero down on bone mineral density (BMD)test. The blood test that is essential is serum calcium, serum alkaline phosphatase (Alk Phos), serum parathyroid hormone (PTH), Vitamin D, thyroid profile and for women above the age of 45 years Follicle Stimulating Hormone (FSH), Leutinising Hormone (LH) to check for onset of menopausal symptoms. The relevance of these tests are as follows :
1. Serum calcium - As I have explained in my previous posts that the reason for loss of bone density is the loss of bone calcium into the blood. Therefore serum calcium levels can be a good indicator for BMD. Normal levels of serum calcium are 8.5 - 10.5 mg/ dL. Elevated serum calcium show hyperparathyroidism or malignancy and decreased levels of calcium show malnutrition and osteomalacia. Hyperparathyroidism as we know is due to the reactivity of the lack of calcium in the blood and imbalance in the remodelling and modelling of the bone. However if the levels show decline in calcium it means that there isn't enough calcium in the body to be mineralised in the bone and hence high PTH would again try to remove calcium from bones to level blood calcium. Malnutrition is the major reason for a drop in blood calcium levels. Malnutrition could be lack of dietary calcium or Vitamin D or due to asymptomatic intestinal disease like celiac sprue, chronic intestinal irritability,intestinal cancer etc.
2. Serum Vit D - Vit D as we all know by now is a factor important in the absorption of calcium in the gut but also for its mineralization in the bones. Serum Vit D of > 32 ng / ml is considered normal. Vit D levels need to be adjusted by supplementation through oral vials or injection.
3. Serum PTH - Parathyroid hormone is the most crucial factor to determine the onset of osteoporotic activity in the bones. The serum elevated levels of PTH signify the loss of bone mineral density and aggrevation of remodelling sites in the bones cells, also the elevation of calcium in the blood and alkaline phosphatase. Normal levels of serum ALP is 20 - 140 IU/ L. Bone alkaline phosphatase levels elevate as it is a byproduct of the bone activity. Imbalance in the ratio of remodelling to modelling sites can lead to elevation of ALP levels. PTH levels when found declined can mean malignancy (cancerous) of the bone. Further biopsy will be required to indentify malignancy. PTH levels can also be elevated if TSH levels are imbalanced therefore a proper TSH, T3, T4 levels of the thyroid activity should be checked.
4. FSH and LH - In women who are in their perimenopausal stage around the age of 45 - 50 years and in given recent scenario even lesser age group have lower estrogen levels in their blood which only means their stimulating hormones will have elevated levels in the blood. Lower estrogen only means that there is certainly going to be imbalance in the bone mineral ratio, PTH will be elevated as estrogen brings about more bone reodelling sites and could also navigate into the inner (trabeculae) bone cells to weaken the structure.
Now you know your tests and you know what the test results translate into, but be sure to know that detecting osteoporosis can also mean detecting an underlying disorder which has been laying there silent all this while. Most of the times treating the primary cause of osteoporosis takes care of the bone disorder itself. Be sure of any such disorder priotise to treat it first and follow the therapy I have earlier explained for osteoporosis.
I will soon be writing on the diet therapy for osteoporosis and busting many myths too. So keep reading and see you here soon.
Wish you wellness,
Neha Wasnik
R.D
Related articles - http://wellnessandi.blogspot.com/2009/08/osteoporosis-metabolic-cause-and.html
http://wellnessandi.blogspot.com/2009/09/exercise-for-osteoporosis.html
