Osteoporosis Flashcards
Define Osteoporosis
Skeletal disease characterised by reduced bone density and micro-architectural defects in bone tissue, resulting in increased bone fragility and susceptibility
T score < -2.5
Aetiology of Osteoporosis
Low peak bone mass or loss of bone mass with ageing
Post-menopasual
Secondary:
Malignancy: myeloma, metastatic carcinoma
Endocrine: Cushing’s, thyrotoxicosis, primary hyperPTH, hypogonadism
Drugs: corticosteroids, heparin
Rheumatological: RA, ank spond
GI: Crohn’s, UC, Coeilac, gastrectomy, PBC
Risk factors for Osteoporosis
Prior frangibility fracture Female White Older age Low BMI Family Hx Post-menopause Secondary amenorrhoea Primary hypogonadism Smoking and alcohol Low calcium or vit D Glucocorticoid/corticosteroid use
Symptoms of Osteoporosis
Asymptomatic until fractures occur
Femoral neck fractures after minimal trauma
Vertebral fractures
Back pain
Impaired vision
Weakness
Balance issues
Colle’s fracture (distal radius after fall onto outstretched hand)
Signs of Osteoporosis on examination
Kyphosis
Impaired gait, imbalance and lower-extremity weakness
Vertebral tenderness, esp. on percussion
Severe pain with leg shortened and externally rotate (NOF fracture)
Investigations for Osteoporosis
DEXA: T-score < -2.5
FRAX -> 10yr fracture probability
Serum calcium, albumin, creatinine, phosphate, 25-hydroxy vit D, PTH: calcium/Cr/phosphate/vit D normal, PTH normal or elevated
Alkaline phosphatase: normal (rule out osteomalacia)
Biochemical markers of bone resorption and bone formation (deoxypyridinoline + N-telopeptides)
Quantitate US of the heel: predictive of hip fracture
X-ray: may reveal osteopenia and/or fractures but often normal
CT: reduced trabecular bone density