Osteoporosis

Question 1

Define Osteoporosis?

Answer 1

Reduced bone density resulting bone fragility and increased fracture risk

Question 2

What is Reduced Bone Density defined as?

Answer 2

> 2.5 standard deviations below peak bone mass achieved by healthy adults (i.e T-score > 2.5)

Question 3

What are the primary causes of Osteoporosis?

Answer 3

Idiopathic (if < 50 yrs)

Post-menopausal

Question 4

What are the secondary causes of Osteoporosis?

Answer 4

Malignancy 
Endocrine
Drugs
Rheumatological
Gastrointestinal

Question 5

What malignancies can cause Osteoporosis?

Answer 5

Myeloma

Metastatic carcinoma

Question 6

What are the endocrine causes of Osteoporosis?

Answer 6

Cushing’s Disease
Thyrotoxicosis
Primary Hyperparathyroidism
Hypogonadism

Question 7

What drugs can cause Osteoporosis?

Answer 7

Corticosteroids

Heparin

Question 8

What are some of the Rheumatological causes of Osteoporosis?

Answer 8

Rheumatoid arthritis

Ankylosing Spondylitis

Question 9

What are some of the gastrointestinal causes of Osteoporosis?

Answer 9

Malabsorption (e.g. coeliac disease, partial gastrectomy)
Liver disease (e.g. primary biliary cirrhosis)
Anorexia

Question 10

What are the risk factors for Osteoporosis?

Answer 10

Age 
Family history 
Low BMI
Low calcium intake
Smoking 
Lack of physical exercise 
Low exposure to sunlight 
Alcohol abuse 
Late menarche 
Early menopause 
Hypogonadism

Question 11

What is the epidemiology of Osteoporosis?

Answer 11

Common
In > 50 yrs 
Females : 1/3 
Males : 1/12 
More common in CAUCASIANS than Afro-Carribeans

Question 12

What are the presenting symptoms of Osteoporosis?

Answer 12

Often Asymptomatic until fractures occur

Question 13

What are the characteristic fratures of Osteoporosis?

Answer 13

Neck of femur (until minimal trauma)
Verterbral Fractures (leading to loss of height, stooped posture and acute back pain on lifting)
Colles’ fracture (of the distal radius after falling on an outstretched hand)

Question 14

What are the signs of Osteoporosis on physical examination?

Answer 14

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 15

What bloods would you do for Osteoporosis?

Answer 15

Calcium
Phosphate
ALP
These are normal in PRIMARY Osteoporosis

Question 16

How do we use X-Ray to investigate Osteoporosis?

Answer 16

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 verterbrae and crush fractures

Question 17

How do we use Isotope Bone Scans for Osteoporosis?

Answer 17

Highlights areas of stress and microfractures

Question 18

What is a T-Score in a DEXA scan?

Answer 18

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

Question 19

What is the Z-score in a DEXA scan?

Answer 19

The number of standard deviations the measurement is above or below the age-matched mean bone mineral density

Question 20

How can we use Z-Score?

Answer 20

Can be helpful in identifying patients who may need a work-up for secondary causes of osteoporosis