Osteoporosis Flashcards
1
Q
Define osteoporosis
A
Osteoporosis is a low bone density (below 2.5 on DEXA Scan) it is caused by loss of trabecular bone
2
Q
Explain the aetiology / risk factors of osteoporosis
A
- There can be high turnover or low turnover osteoporosis, but in both cases the rate of resorption exceeds the rate of bone production
- The net effect is is increase bone resorption of trabecular bone leading to REDUCED BONE MASS
Primary Osteoporosis: Age and Post-Menopause
Secondary Osteoporosis: all other causes
- High turnover causes:
- Oestrogen deficiency (OCP, menopause)
- hyperparathyroidism
- Heparin
- hyperthyroidism
- Primary hypogonadism
-
Low turnover:
- Liver disease
- Heparin
- Glucocorticoids/Cushing’s cause increased resorption and decreased formation
3
Q
Recognise the presenting symptoms of osteoporosis
A
- Often ASYMPTOMATIC
- Back pain
- Fragility fractures
- Colle’s fractire
- Neck of femur fracture
- Lumbar spine
4
Q
Recognise the signs of osteoporosis on physical examination
A
- Bone tenderness
- Imapired gait and imbalance
5
Q
Identify appropriate investigations for osteoporosis and interpret the results
A
- Dual-energy X-ray Absorptiometry (DEXA):
- This assesses BMD and generates a T-score (BMD comparison to healthy 25 year old) or Z-score (BMD age-matched comparison)
- Generate a FRAX score, which is 10 year fracture risk
- X-ray: Osteopenia, fractures
- Urine NTx/Serum CTX : increased as its a sign of resorption
- P1NP: Decreased as it’s a marker for bone formation
TESTS FOR EXCLUSION:
- Serum VitD
- TFT
- Serum PTH
- Testosterone
- Cortisol
