Osteoporosis (Complete) Flashcards
Define osteoporosis
Low bone mass and structural deterioration of bone tissue leading to increased risk of fracture
What are the 3 most common locations for osteoporotic fractures?
Wrist
Hip
Spine (including ribs)
List some risk factors for osteoporotic fractures (10)
Risk factors reducing bone density:
Low body weight
Menopause
Immobility
Chronic conditions:
- CKD
- COPD
- Chronic liver disease
Malabsorption:
- Coeliac disease
- IBD
- Pancreatic insufficiency
Endocrine conditions
- Hyperparathyroidism
- Hyperthyroidism
- Hypogonadism
Medications:
* PPI
* SSRi
* Carbamazepine
Risk factors that do not reduce bone density:
Old age
Inflammatory arthritis
Oral corticosteroids
Smoking
Alcohol excess
Previous fracture
Parental history of hip fracture.
Males presenting with osteoporosis should always be checked for what condition?
Hypogonadism (Assess testosterone levels)
Hypogonadism is a common cause of osteoporosis in males esp if presenting at young age)
What is the most typical presentation of osteoporosis?
Tends to be assymptomatic until a fracture occurs
A fracture that occurs due to increased bone fragility is known as?
An osteoporotic fracture
What are the main clinical features suggestive of osteoporotic fracture?
Osteoporosis risk factors alongside:
Acute severe pain
Difficulty weight bearing
Signs of vertebral fracture:
Back pain
Kyphosis and loss of height
Vetebral tenderness
Signs of hip fracture:
Shortened and externally rotated leg
Signs of wrist fracture:
“Dinner-fork” deformity
What is the diagnostic investigation of patients suspected of having osteoporosis?
Dual energy X-ray absorptiometry (DXA).
When performing a dual energy X-ray absorptiometry (DXA), what must the T-score be for an individual to be diagnosed with osteoporosis?
T-score ≤ -2.5
T-score ≤ -2.5 with fragility fracture(s) indicates severe (or established) osteoporosis
What T-score values are suggestive of osteopenia?
-1 to -2.5
What are some investigations to consider in patients suspected of osteoprosis to rule out differentials and support diagnosis?
Bedside:
Urinalysis:
- Urine electrophoresis: Rule out Bence Jones proteinuria seen in multiple myeloma
- Urinary free cortisol: Rule out cushings
Bloods:
FBC: Check for anaemia seen in malignancy
ESR/CRP: Check for inflammatory arthritis as underling risk factor
U&Es: Check CKD as risk factor
LFTs: Check LFTs as underluing risk factor
Vitamin D: Check for supplementation
Bone profile: Check calcium for supplementation
TFTs: Check hypothroidism
Testosterone: Hypogonadism
Serum protein electrophoresis: (Rule out myeloma)
Imaging:
DXA: Diagnostic
X-ray (Identify any fractures or vertebral bone deformities)
What X-ray findings are suggestive of osteoporosis?
Usually none unless there is an osteoporotic fracture
What histological findings are suggestive of osteoporisis?
Loss of cancellous bone
List 6 examples of possible differentials in patients suspected of osteoporosis. (6)
Multiple myeloma
Osteomalacia
Chronic kidney disease-bone mineral disorder
Primary hyperparathyroidism
Metastatic bone malignancy
Vertebral deformaties
How can osteoporosis and multiple myeloma be differentiated based on clinical presentation and investigation findings?
Multiple myeloma tends to present with bone pain and symptoms of anaemia and renal failure
Urine electrophoresis reveals Bence Jones proteinuria
Serum electrophoresis reveals monoclonal gammopathy
How can osteoporosis and osteomalacia be differentiated based on clinical presentation and investigation findings?
Difficult to differentiate
PTH levels are elevated in osteomalacia and bone biopsy would show confirmation of poor mineralisation
Serum alkaline phosphatase (elevated)
How can osteoporosis and chronic kidney disease-bone mineral disorder be differentiated based on clinical presentation and investigation findings?
Difficult to differentiate clinically.
They may have a history of renal failure, may present with bone pain or diminished strength.
These patients would have elevated PTH and serum creatinine
How can osteoporosis and primary hyperparathyroidism be differentiated based on clinical presentation and investigation findings?
Signs of hypercalcaemia: e.g. anorexia, nausea, abdominal pain, ( “painful bones, renal stones, abdominal groans, and psychic moans,”).
Elevated PTH
Elevated serum calcium
How can osteoporosis and metastatic bone malignancy be differentiated based on clinical presentation and investigation findings?
Known medical history of cancer
Bone pain after minor injuries in atypical locations
Dual-energy x-ray absorptiometry may be normal.
CT may show presence of tumour.
Bone scan shows multiple hot spots.
Definitive test is bone biopsy and appropriate investigations to determine primary.
How can osteoporosis and vertrebral bone deformaties be differentiated based on clinical presentation and investigation findings?
This is difficult to differentiate clinically from osteoporosis.
Spinal deformities such as osteoarthritis and scoliosis may be mistaken for osteoporotic vertebral fractures.
X-ray and further imaging are required for diagnosis.
How does the T-score differ between osteoporosis and osteopenia
Osteoporosis ≤-2.5
Osteopenia: <-1 but >-2.5
Normal: ≥-1
What is the main goal of treatment in patients with osteoporosis?
Prevent fractures
What is the management plan for patients with osteoporosis?
_ Conservative_:
Regular weight-bearing exercise (to strengthen bones in patients who are mobile enough to)
Risk factor modification
Medicine:
Oral bisphosphonates: First-line
- Alendronate (Alendronic acid)
- Risendronate
Calcium suplements
Vitamin D supplements
Surgical:
Surgical management of fractures if indicated
