Have you had fractures after minor injuries, reached menopause, received long-term glucocorticoid treatment, or are you planning spinal fixation? Bone strength should be assessed. Professor Iakiv Fishchenko can help determine which existing findings matter for your spine treatment plan and whether further assessment is needed before surgery.
What determines bone strength and fracture risk?
Bone condition is affected by age, heredity, hormones, diseases and treatment. These are assessed alongside previous fractures, bone mineral density and the risk of falls.
Risk factors help determine the need for assessment and prevention. Diagnosis and treatment planning depend on the full clinical picture. An important aim is to recognise an increased fracture risk in time and prepare the bone if surgery is planned.[1]
Age, menopause and hormonal changes
The combination of circumstances determines the need for assessment. At a younger age, a fracture after minor stress or a disease affecting bone also warrants attention.[1]
Heredity and low body weight
Tell your doctor if your mother or father had a hip fracture. This is an important family risk factor considered when assessing the likelihood of future fractures.
Low body weight, inadequate nutrition or substantial weight loss can also affect bone strength. Your current height and weight, and information about changes in them, are useful for the consultation. An appearance of “thin bones” does not replace assessment of bone density and clinical risk.[1]
A previous fracture is an important warning sign
A vertebral, hip or other characteristic fracture after a minor injury raises concern about bone fragility. Even a fracture found incidentally on imaging can change the risk assessment.
State when and under what circumstances the injury occurred. Height loss, increasing stooping or new back pain are reasons to discuss whether assessment for a vertebral fracture is needed.[1]
Vertebral compression fractures: investigations and treatment choice
Conditions that can weaken bone
Sometimes reduced bone strength is related to another disease. This requires investigation and treatment of a secondary cause. Important examples include:
- prolonged untreated excess thyroid hormone and other endocrine disorders;
- hypogonadism — insufficient function of the sex glands;
- impaired nutrient absorption, prolonged inadequate nutrition or substantial weight loss;
- rheumatoid arthritis and other chronic conditions that may affect bone and activity;
- diabetes, kidney or liver disease, taking account of the specific diagnosis and its course.
Such a diagnosis helps guide the choice of tests and specialist consultations. Investigations are selected individually, without a standard hormone panel for everyone.[1]
Medication that needs to be considered
Long-term systemic glucocorticoid use is particularly important. Certain anticancer hormonal treatments can also affect bone, including aromatase inhibitors and androgen deprivation.
Send the exact medicine names, doses and treatment durations. For some medicines, risk relates to the dose, duration or underlying condition; it should not be extended to the entire drug class.
Do not stop treatment yourself. A bone-protection plan and possible treatment changes are agreed with the prescribing doctor.[2]
How risk is assessed: DXA, FRAX and blood tests
DXA bone densitometry measures bone mineral density. FRAX helps estimate the probability of a fracture over ten years. These tools complement clinical assessment; the need for them depends on age, fractures, medical conditions and medication.[1]
DXA results are interpreted according to age group. After menopause and in men aged 50 and over, the T-score is preferred; before menopause and in men younger than 50, the Z-score is preferred. A single result in a young person should not automatically be equated with an osteoporosis diagnosis.
Degenerative spinal changes can affect the measurement. The doctor assesses study quality and the regions used to draw the conclusion. Tests are requested to investigate possible secondary causes and plan treatment.[3]
Why this matters before spinal fixation
When screws and an interbody cage are inserted, bone strength affects support for the construct and fusion. If osteoporosis is suspected, assessment before surgery helps plan preparation and the fixation method.
At the consultation, I consider fracture history, existing DXA and CT findings, and laboratory results when indicated. If necessary, we arrange further bone assessment and preparation for surgery. This approach also matters with minimally invasive access.[4]
Pedicle screw fixation and interbody cage placement · Osteoporosis prevention and treatment
What to prepare for your consultation
- Existing DXA results — the complete report with measurement regions and date.
- Fracture history and discharge summaries: date, injury circumstances and treatment provided.
- A list of regular medicines with doses and treatment durations.
- Information about other medical conditions, menopause or previously diagnosed hormonal disorders, as well as parental hip fracture.
- Existing blood tests and spine images — if available. If surgery is planned, include the preliminary recommendations for it.
Start with the documents you already have. After review, we will determine what needs clarification for spine treatment or preparation for surgery. If you send MRI/CT scans, complete DICOM series are needed.
Questions about biological risk factors
Can men develop osteoporosis?
Yes. Assessment considers age, fractures, hormonal disorders, other conditions and medication. Bone assessment is needed when appropriately indicated.
If my parents had fractures, do I also have osteoporosis?
Family history increases attention to risk but does not establish a diagnosis. It is assessed together with other findings and investigation results.
Do all hormones need to be tested?
No. Tests are selected based on symptoms, medical history, medication and the initial assessment. It is important to look for a cause that could change the treatment plan.
Can spinal fixation be planned with osteoporosis?
The need for surgery and its extent are determined by the spinal condition. Bone condition affects preparation and construct selection; we discuss these issues before surgery.
Discuss bone condition and preparation for surgery
Send Professor Iakiv Fishchenko existing DXA results, fracture discharge summaries, a medication list and spine images. Preliminary review will help prepare an in-person consultation and determine the next steps. Review of investigations is free.
Send your scans to Professor Fishchenko
Osteoporosis treatment and prevention · About the professor · Contact and appointments in Kyiv