Osteoporosis Flashcards
What are two cardinal changes of osteoporosis?
Low BMD
Micro-architectural disruption– “bone quality”
What are the rates of osteoporosis in women? In men?
Are certain racial groups more susceptible?
1 in 2 women
1 in 5 men
More common in caucasian/asian ancestry
Which fractures are most common? How do they present?
Vertebral fractures– 2/3 are asymptomatic
Chronic pain, deformity and increase in morbidity and mortality can result
Which fracture is most concerning? What are mortality rates during first year?
Hip fractures are most serious
Mortality rates during first year:
30% in men
17% in women
What are the two main causes of low bone density?
Low peak bone mass “Modeling”
Excess bone loss later in life “remodeling” (i.e due to loss of estrogen in postmenopausal women)
What are primary causes of osteoporosis? Secondary causes? (list)
No known cause in postmenopausal women/aging men
Secondary osteoporosis causes include glucocorticoids or genetic diseases, lifestyle factors, endocrine disorders, GI disorders, hematological disorders, other medications, rheumatological disorders
Diagnosis of osteoporosis: DXA scan
What sites are used? What measurements are used, and for which populations?
Total hip, femoral neck, lumbar spine, forearm (if hyperparathyroidism, hip replacement pts)
T-score used for diagnosis– compares to normal young adult control
Z-score used to predict propensity for developing osteoporsis–compares to age/race/gender-matched controls.
What are parameters for normal, low bone mass and osteoporosis on DXA scan?
Normal: T>-1
Low bone mass (osteopenia): T between -1 and -2.5
Osteoporosis: T
What is severe/established osteoporosis?
Patients with T
Interpretation of T-score in DXA scan– which areas do you use? Which value do you use– total or lowest observed?
Femoral neck and lumbar spine
Use lowest observed T-score
Who should be screened for osteoporosis?
Difference for clinical risk factors?
No clinical risk factor: Women>65, men>70
Risk factors: Younger postmenopausal women, men between 50 and 69
A decrease in one SD in BMD is associated with what increase in fracture risk?
The fracture risk doubles with every SD decrease in BMD
What are risk factors for osteoporosis that are considered in fracture risk assessment tool (FRAX)? (8)
Age, low BMI, previous facture, family history of hip fracture, current smoking, alcohol, glucocorticoids, secondary cause of osteoporosis (i.e RA)
What probabilities does FRAX give? Which values are high enough to warrant treatment?
FRAX measures risk for osteoporotic fracture and for hip fracture
Treat puts with
>20% for all osteoporotic fracture
>3% for hip fracture
In general what is criteria for treatment?
Postmenopausal women, men>50
T-score 20% osteoporotic fracture, >3% hip fracture
