Osteoporosis is a common disorder that is often neglected in clinical practice. While cost issues preclude recommending widespread screening with BMD measurements, the clinician should be alert to the situations where BMD testing is warranted so that appropriate preventive therapy can be instituted.

Currently, DXA remains the method of choice for assessing bone mass and predicting the risk of fracture. In limited circumstances, markers of bone turnover may provide additional prognostic information and also be useful in monitoring the response to therapy. Further laboratory evaluation of the patient with osteoporosis should focus on excluding secondary causes and assiduously following up on the leads provided by a thorough history and physical examination. X-rays are useful for assessing the presence of vertebral deformities, but cannot replace BMD testing for making a diagnosis of osteoporosis. Based on these considerations, the goal of the evaluation should be to optimally diagnose and treat this common disorder, without incurring undue costs to the healthcare system.