Also, bone loss and fractures rise after liver or heart transplants. Sometimes the first indication of osteoporosis is x-ray detection of compression fractures of the spine, which frequently occur without the person's knowledge or produce back pain that prompts the patient to seek help. In advanced stages, osteoporosis is easily recognized by loss of height and the dowager's hump. Ideally, however, the disease should be diagnosed and treated before these changes transpire. A detailed history of medical problems, lifestyle, and familial data can identify risk factors and secondary causes that suggest osteoporosis.
Biochemical markers can reveal the integrity of bone remodeling.
Bone formation is measured by several serum markers, including osteocalcin and bone-specific alkaline phosphatase, which has greater specificity than total alkaline phosphatase. Painless and noninvasive, this test uses very low-dose radiation. Even women as late as 15-20 years postmenopause have shown gains in spinal BMD when they take estrogen. In fact, these gains may be greater than with women who are early postmenopause. HRT is not recommended in the presence of breast or other estrogen-dependent cancers.