Osteoporosis

Question 1

def

Answer 1

reduced bone density (defined as <2.5 SDs below peak bone mass achieved by healthy adults i.e. T-score

Question 2

def of osteopenia

Answer 2

T score between -1.0 & -2.5

Question 3

aetiology

Answer 3

primary
-idiopathic
-post menopausal
secondary
-malignancy (myeloma, metastatic carcinoma)
-endocrine (cushings disease, thyrotoxicosis, primary hyperparathyroidism, hypogonadism)
-drugs (corticosteroids, heparin)
-rheumatological (RA, ankylosing spondylitis)
-GI (malabsorption syndromes e.g. coeliacs)

Question 4

associations/risk factors

Answer 4

age, family history, low BMI, smoking, lack of physical exercise, low sunlight exposure, alcohol abuse
late menarche
early menopause

Question 5

why would late menarche and early menopause be risk factors for osteoporosis

Answer 5

overall reduced oestrogen exposure

Question 6

epi

Answer 6

common
in >50yrs 1/3 of women & 1/12 of men
more common in caucasians

Question 7

history

Answer 7

often asymptomatic until fracture
femoral neck fractures common after minimal trauma
vertebral fractures (loss of height or stooped posture)
colles fracture

Question 8

what is Colles’ fracture

Answer 8

fracture of the distal radius after fall onto outstretched hand

Question 9

examination

Answer 9

often no signs until complications develop
-tenderness on percussion over vertebral fractures
thoracic kyphosis
severe pain with legs shortened and externally rotated

Question 10

investigations

Answer 10

1 blood
-ca, po4(3-), alk phos are normal in primary osteoporosis
2 X-ray
-for diagnosis of fractures
-often normal
-there must be >30% loss of density before radiolucency
3 bone densitometry (dual-energy X-ray absorptiometry) for obtaining T and Z scores
-T-score is no. of SDs bone mineral density measurement is above or below young normal mean bone mineral density, used to define osteoporosis
-Z-score is no. of SDs the BMD measurement is above or below the age matched mean BMD