Osteoporosis / Metabolic Bone Disease Service

The Metabolic Bone Disease/Musculoskeletal Oncology Service provides clinical care and treatment for osteoporosis, Paget's disease and related bone disorders. It is also responsible for the orthopaedic oncology at the hospital.

Osteoporosis - Frequently Asked Questions

What does my DEXA T score mean?
The most commonly used technique to assess bone density is dual energy x-ray absorptiometry (DEXA). The amount of mineralized tissue within a section of spine or hip is measured and expressed as grams per cm2. Values are compared to sex- and aged-matched controls (Z Score) or to healthy, same sex individuals aged 35 years who are felt to have attained peak bone mass (T Score). For more information, click here to read our full In-Depth Disease Overview on Osteoporosis.

So what DEXA score means I have osteoporosis?
The World Health Organization (WHO) has established criteria for the diagnosis of osteoporosis:

  • Individuals within one standard deviation of peak bone mass (T score) are considered to have normal bone density.
  • If bone mass is between one and 2.5 standard deviations below peak bone mass (T score), osteopenia is diagnosed.
  • If bone mass is 2.5 standard deviations below peak bone mass (T score), osteoporosis is diagnosed.
  • If the patient has also had a fragility fracture, severe osteoporosis is diagnosed.

What kind of calcium should I take?
The two most available forms of calcium are calcium carbonate and calcium citrate. Either type is an acceptable replacement. Some evidence supports better absorption of calcium citrate. This preparation may be a more judicious choice in patients with achlorhydria or nephrolithiasis. It can be taken with or without meals. Calcium carbonate is better absorbed with meals because it requires an acid stomach for maximal absorption. For more information, click here to read our full In-Depth Disease Overview on Osteoporosis.

When do I need to take medication?
Most authorities, including the National Osteoporosis Foundation, recommend the addition of antiresorptive therapy if the T score is -1.5 SD or greater with major risk factors for fracture, or - 2.0 SD or greater without risk factors. Of course, decisions about treatment must be made based on each individual's bone density and associated medical conditions.

How do drugs for osteoporosis work?
Drugs now prescribed slow bone destruction and resorption. They include:

  • bisphosphonates such as alentronate and risedronate, taken as pills once daily or once weekly, depending on the dose;
  • estrogen replacement for post-menopausal women, taken as pills once daily
  • selective estrogen receptor modulators (SERMs) such as tamoxifen and raloxifene, taken as daily pills.
  • calcitonin, a nasal spray

Are there any new procedures to fix fractures in my back?
Yes, there are. Vertebroplastyinvolves injecting cement directly into fractured vertebral bodies. This has been shown to decrease pain, increase mobility and improve spine stability. There is no effect on fracture reduction or deformity. Kyphoplasty involves using an inflatable bone tamp to inject bone void filler under low pressure into the involved vertebral body. The fracture may be reduced, and pain relief is rapid. Both of these new techniques are available at HPH.