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

The approach to the diagnosis of osteoporosis has undergone a radical chang e in recent years. Osteoporosis is defined as a state of microarchitectural deterioration of the skeleton predisposing that skeleton to fragility frac ture. In this sense it is a risk factor for disease in the same way as hype rtension is a risk factor. Previously it was considered that bone density m easurements using X-ray technology was the best non-invasive method of meas uring the microarchitectural deterioration which thus came to define the di sease. With the advent of new technology and a more logical approach to ris k evaluation this simple approach is no longer appropriate. This chapter takes a stepwise approach to assessing the likelihood of osteo porosis on the basis of clinical factors and then suggests a method of inte grating this information with a bone density measure to achieve a predictio n of future fracture probability. Methods of diagnosing the cause of the os teoporosis are also outlined. Finally, application of these techniques in c linical care is discussed.