The major skeletal determinants of fracture risk are bone mass and postmenopausal bone loss with gradual destruction of trabecular bone architecture. Therefore, the management of osteoporosis is to prevent bone loss after menopause in women below 60 years of age. We need a screening test of bone mineral density (BMD) with the ability to identify correctly individuals with accelerated bone loss; unnecessary treatment has to be avoided. But without measurable extraskeletal factors, no technique assessing BMD as single test has the reasonable high sensitivity and specificity for the diagnosis of fast bone losers. It is on principle the repeated volumetric bone measurement--within 12 months--in the pure trabecular bone, especially at distal radius of the non-dominant arm with the peripheral quantitative computed tomography (pQCT), being able to detect accurately the individuals as fast bone losers with trabecular bone loss > 8 mg/cm3 or > 3.5% per year (prevalence about 35%). Only women with very high trabecular BMD (in highest quintile) have no risk for osteoporosis.

Bratisl Lek Listy. 2000;101(3):179-80.
Early diagnosis of postmenopausal osteoporosis
Killinger Z.

Osteoporosis can be diagnosed by history, physical examination, laboratory test and bone mass measurement. A low bone mass is the most important risk factor for osteoporotic fractures. In the assessment of risk is very important the rate of bone loss too. Combining bone density and bone turnover with age and other associated risk factors can improve the assessment of the risk of osteoporosis especially at the postmenopausal women. As in many medical conditions early diagnosis is the key to success in prevention and treatment in osteoporosis.

J Endocrinol Invest. 1994 Nov;17(10):771-4.
Metabolic markers for the early diagnosis of postmenopausal osteoporosis.
Isaia G, Mussetta M, Di Stefano M, Sciolla A, Triolo S, Molinatti GM.
Istituto di Medicina Interna, University of Torino, Italy.

We performed a cross-sectional study in 147 women, 41 in premenopausal age and 106 in menopause for 1-5 years: bone mineral density (BMD) at the distal radius and annual bone loss (as shown by plasma alkaline phosphatase and osteocalcin levels, and by calcium/creatinine and hydroxyproline/creatinine in the second urine of the morning) were evaluated. A significant reduction of BMD with a significant increase of bone loss was observed with increasing duration of menopause. Furthermore, when the women were subdivided into two groups according to annual bone loss (over or under 1.7%), significant differences were found between bone mineral density in the second and third years of menopause. As this is a cross-sectional and not a longitudinal study, it confirms that, in the presence of a higher bone loss, the BMD levels are lower and consequently the theoretical definition of this parameter can allow useful information on the presumable behavior of BMD.

Fortschr Med. 1990 Apr 15;108(11):219-21.
The new concept of osteoporosis. Early diagnosis, prevention and therapy are possible today
Hesch RD, Harms H, Rittinghaus EF, Brabant G.
Abteilung fur klinische Endokrinologie, Departement Innere Medizin der Medizinischen Hochschule Hannover.

A paradigma of osteoporosis pathology is discussed, at the center of which is the hormone-related disturbance of the osteoblast/osteoclast functional unit. A liberal replacement of estrogen-gestagen in post-menopausal women is advocated. Early diagnosis with the aid of quantitative computed tomography makes it possible to establish the indication for timely hormonal treatment in the future, which can result in a measureable increase in bone mass. Late therapy, that is, treatment initiated after the occurrence of fractures, has proven largely ineffective.

Arch Orthop Trauma Surg. 1990;109(4):181-5.
Calcitonin, estradiol, and hydroxyproline as parameters in the early diagnosis of involutional osteoporosis. The importance of the "second calcitonin phenomenon".
Ferrandez L, Martin M, Fernandez M.
Department of Traumatology and Orthopedic Surgery, Hospital Clinico Universitario, Salamanca, Spain.

Bone metabolism was studied in a group of 92 subjects. A greater age-related decrease in calcitonin and estradiol concentrations exists in women than in men, though this difference was not significant; it was significant, however, when the values of the three different groups of women were compared. We present what we have called the second calcitonin phenomenon, that is, a highly significant difference in women between a second basal calcitonin level and the primary admission value. In the calcium infusion test, men considered to be osteoporotic showed a deceleration in the rapid loss of reserve calcitonin deposits.

Clin Ter. 1991 Apr 15;137(1):21-7.
Early clinical diagnosis of osteoporosis using auscultatory percussion. Therapeutic monitoring
Stagnaro MN, Stagnaro S.
USL 18, Tigullio Orientale, Ospedale di Lavagna.

The authors describe the auscultatory percussion method, easy to perform and reliable in early bed-side diagnosis of osteoporosis, even if asymptomatic. In addition, the great importance of early diagnosis in preventing fractures complicating osteoporosis is underlined. The results obtained with prompt administration of current therapy in 25 cases, diagnosed with the aid of auscultatory percussion, are reported. Finally, practical use of this method for both therapeutic monitoring and individual prescription of drugs, is emphasized.