Clinical Evaluation Of Osteoporossis

Consider the possibility of osteoporosis and fracture risk based on the presence of the risk
factors and conditions outlined in Tables 1 and 3. Metabolic bone diseases other than
osteoporosis, such as hyperparathyroidism or osteomalacia, may be associated with low BMD.
Many of these diseases have very specific therapies, and it is appropriate to complete a history
and physical examination before making a diagnosis of osteoporosis on the basis of a low BMD
alone. In patients in whom a specific secondary, treatable cause of osteoporosis is being
considered (Table 1), relevant blood and urine studies (see below) should be obtained prior to
initiating therapy. Patients with recent fractures, multiple fractures or very low BMD should be
evaluated for secondary etiologies and, when considering osteomalacia or vitamin D
insufficiency, a serum 25(OH)D level should be obtained. Certain routine biochemical tests(such
as serum calcium, creatinine, etc.) are required to determine if there are contraindications to
the use of certain osteoporosis medications.

Osteoporosis affects a significant number of men yet the condition often goes undetected and
untreated. The evaluation of osteoporosis in men requires special consideration as some of the
laboratory testing to assess underlying causes in men differ from those in women. Screening
BMD and vertebral imaging recommendations for men are outlined on page 22. The 2012
Endocrine Society's "Osteoporosis in men: an Endocrine Society clinical practice guideline"
provides a detailed approach to the evaluation and treatment of osteoporosis in men.
15