Osteoporosis Flashcards

1
Q

Define osteoporosis?

A

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

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2
Q

outline the aetiology of osteoporosis?

A

low peak bone mass or loss of bone mass with ageing

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

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3
Q

what are the primary causes of osteoporosis?

A

idiopathic ( if less han 50 years old)

post- menopausal

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4
Q

what are the secondary causes of osteoporosis?

A

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
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5
Q

what are the risk factors for osteoporosis?

A
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6
Q

summarise the epidemiology of osteoporosis?

A

White, postmenopausal women

Fracture risk increases with age

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7
Q

what are the presenting symptoms of osteoporosis?

A

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)

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8
Q

what are the signs of osteoporosis on physical examination?

A

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)

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9
Q

what are the appropriate investigations for osteoporosis

A

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

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10
Q

described blood results for osteporosis?

A

Calcium

Phosphate

ALP

IMPORTANT: these are NORMAL in PRIMARY osteoporosis

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11
Q

what is the t score?

A

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

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12
Q

what is the z score?

A

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

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