Osteoporosis

Question 1

Define osteoporosis?

Answer 1

reduced bone density ( more than 2.5 density below peak mass achieved by healthy adults of the age and gender ( T score

Question 2

outline the aetiology of osteoporosis?

Answer 2

low peak bone mass or loss of bone mass with ageing

imbalance in bone remodellig process ( osteoclasts)- bone resorption greater than bone formation

Question 3

what are the primary causes of osteoporosis?

Answer 3

idiopathic ( if less han 50 years old)

post- menopausal

Question 4

what are the secondary causes of osteoporosis?

Answer 4

ME DR G

maligancy- myeloma, metastatic, carcinoma

Endocrine - cushings disease, thyrotoxicosis, primary hyperparathyroidism, hypogonadism

Drugs- corticosteroid, heparin

Rheumatology- rheumatoid arthritis, ankylosing spondylitis

Gastrointestinal

• malabsorption ( coeliac disease, partial gastrectomy)
• liver disease ( primary biliary cirrhosis)
• anorexia

Question 5

what are the risk factors for osteoporosis?

Answer 5

Question 6

summarise the epidemiology of osteoporosis?

Answer 6

White, postmenopausal women

Fracture risk increases with age

Question 7

what are the presenting symptoms of osteoporosis?

Answer 7

asymptomatic until fractures occur

characteristic fractures

• *- Neck of femur ( after minimal trauma)
• vertebral fractures** ( leading to loss of height, stooped posture and acute back pain)

- colle’s fracture ( distal radius after falling on an outstretched hand)

Question 8

what are the signs of osteoporosis on physical examination?

Answer 8

Often NO SIGNS until complications develop:

Tenderness on percussion (over vertebral fractures)

Thoracic kyphosis (due to multiple vertebral fractures)

Severe pain when hip flexed and externally rotated (suggests NOF fracture)

Question 9

what are the appropriate investigations for osteoporosis

Answer 9

Bloods- calcium, phosphate , ALP=>allnormal

X-Ray

• Used to diagnose fractures
• Often normal because it takes > 30% loss of bone density before showing any changes in radiolucency or cortical thinning
• May show biconcave vertebrae and crush fractures

Isotope Bone Scans

• Highlights areas of stress and microfractures

DEXA (Dual-Energy X-Ray Absorptiometry) Scan

T-score: the number of standards deviations the bone mineral density measurement is above or below the young normal mean bone mineral density

Z-score: the number of standard deviations the measurement is above or below the age-matched mean bone mineral density. Z-score may be helpful in identifying patients who may need a work-up for secondary causes of osteoporosis

Question 10

described blood results for osteporosis?

Answer 10

Calcium

Phosphate

ALP

IMPORTANT: these are NORMAL in PRIMARY osteoporosis

Question 11

what is the t score?

Answer 11

the number of standards deviations the bone mineral density measurement is above or below the young normal mean bone mineral density

Question 12

what is the z score?

Answer 12

the number of standard deviations the measurement is above or below the age-matched mean bone mineral density. Z-score may be helpful in identifying patients who may need a work-up for secondary causes of osteoporosis