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If my tests show I have bone loss, do I need to be referred to a specialist? Or can my primary care provider or my gynecology clinician manage my case?

Sometimes, BMD testing sites have their own clinicians. They are familiar with the BMD testing equipment and interpreting the results. You may be prescribed medication and told to follow up with them in several months. When your primary care provider (PCP) or gynecology clinician (GYN)[1] orders your tests, you should discuss who will be interpreting the test results and if you will be referred to a specialist.

Most primary care providers can manage your care if you are newly diagnosed with osteoporosis or have just found out you have osteopenia. It may become necessary, depending on other medical conditions that you have or the medications you take, to refer you to a specialist in osteoporosis. This specialist is often an endocrinologist[2] or rheumatologist[3].

Many women see their GYN clinician annually in place of regular primary care check-ups. GYN clinicians can order BMD testing, provide you with the results, recommend therapies and lifestyle changes, and prescribe medications. If you have other conditions that may affect your bone health, it is advisable to also have a primary care clinician who can review all of your medications and history as they relate to osteoporosis.

If you have spinal fractures, you may be referred to an orthopedist[4] (a doctor who specializes in the treatment of the skeleton system and its muscles, joints, and ligaments)[5]. Although rarely used today, a special brace for your back may be recommended (see Question 83). Orthopedists usually don't prescribe the medications that are used to treat or prevent osteoporosis, unless the medication is needed for a fracture (see Question 63). Your PCP or GYN clinician usually prescribes medications for prevention and treatment. If you see different clinicians for your primary care, bone health, and GYN care, you must inform all of them about the therapies being used to manage your osteopenia or osteoporosis.

Are there blood and urine tests that can be used to determine if I have bone loss?

In the case of osteoporosis, biochemical "markers" are chemical substances that indicate bone turnover. When osteoclasts (the cells of bone resorption; see Question 4) break down the collagen in bone, byproducts of this breakdown (for example, N-teleopeptide crosslinks [NTx]) are released into the bloodstream and excreted in the urine. When new bone is formed, byproducts such as osteocalcin and other substances also find their way to the bloodstream and get excreted in the urine. By measuring the byproducts of bone breakdown (usually in the urine) and bone formation (usually in the blood), the rate of bone turnover can be determined. If bone turnover is very rapid, like it is in women following

If bone turnover is very rapid, like it is in women following menopause, the quality of bone may be poor, thus increasing the risk of fracture.

menopause, the quality of bone may be poor, thus increasing the risk for fracture.

Currently, blood and urinary biomarkers are not used to diagnose osteoporosis, but they can be helpful in assessing how fast bone is formed and broken down. BMD testing, while important for assigning fracture risk and measuring bone mass, does not provide information about bone turnover or bone quality. Tests for biomarkers do not give any information about bone mass; however, there is some evidence that the presence of bone breakdown biomarkers in urine is associated with an increased risk of hip fracture.

While the tests are relatively simple, there is not enough consistency between tests for them to be used widely, even for monitoring the course of treatment. Research has yet to confirm that biomarkers could be used routinely to monitor the effectiveness of treatment. There is some evidence based on urinary biomarkers, however, that individuals with high bone turnover have the best response to certain treatments, and those with reduced amounts of the markers, which indicate bone resorption (breakdown), also had fewer vertebral fractures. Other research demonstrates that urine biomarkers can show bone's response to medications in as little as 6 weeks, which is much faster than the traditional follow-up BMD testing done after 1 to 2 years of treatment. The future hope is that medications for osteoporosis could be changed to different ones more quickly if bone weren't responding in the intended way, based on the urinary biomarkers.

  • [1] A nurse practitioner, midwife, physician assistant, or physician who specializes in the practice of gynecology, the health care of women.
  • [2] Physician who specializes in the care of people with hormone disorders such as diabetes, thyroid problems, and osteoporosis.
  • [3] Physician who specializes in the care of people with disorders related to joints, bones, tendons, and muscles. Unlike a surgeon, does not perform surgery on joints and bones.
  • [4] A physician who specializes in the treatment and surgery of bone and joint disorders.
  • [5] Tough bands that connect bones to each other.
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