[Staged diagnosis in osteoporosis. Is your patient at risk for fractures?]

Diagnosing the various forms of osteoporosis may be difficult, and a systematic, stepped approach is to be recommended. The most important first step is the analysis of the individual anamnestic risk factors and their weighting within the overall situation. An accumulation of anamnestic risk factors increases the osteoporosis risk as also, in elderly women, the risk of sustaining a fracture as a result of a fall, in the event of a demonstrated elevated osteoporosis risk, "typical" symptoms, or relevant examination findings, an X-ray of the lumbar and thoracic spine and, where indicated, bone density measurements on the lumbar spine and/or hip, should be obtained. In addition, a minimal laboratory investigation aimed at excluding secondary forms of osteoporosis should be initiated. If secondary osteoporosis is suspected, further investigations are indicated. Anamnestic risk factors, a prevalence of osteoporotic fractures, low bone density and accelerated bone turnover are in part independent risk factors that augment one another. Of overriding practical importance is the early identification and selective effective treatment of patients with a high fracture risk.