[Diagnostic procedure in osteoporosis]

Osteoporosis is a very important differential diagnosis in chronic back pain. Early diagnosis of osteoporosis remains difficult, as an initial loss of skeletal mass cannot be recognized in X-ray pictures. A clear assessment can only be reached by the application of different non-invasive quantitative methods of bone mineral determination. So far as possible bone mineral content should be measured at an axial and a peripheral site of the skeleton. Crush fractures of vertebrae indicate an advanced calcipenic osteopathy. During the diagnostic procedure of osteoporosis other metabolic osteopathies (e.g. the different forms of hyperparathyroidism and osteomalacia) must be excluded by laboratory examinations or sometimes even by bone histology. If other generalised osteopathies can be excluded one has to look for etiological factors of a possible form of secondary osteoporosis because some of these allow a specific therapeutic approach. In about 80% no disturbances of calciumphosphorous metabolism can be detected, which means that a diagnosis of primary (idiopathic) osteoporosis must be made. In primary and secondary forms of osteoporosis the actual skeletal status and the activity of the osteoporotic process should be defined before beginning a differentiated treatment.