week 12- osteoporosis Flashcards
osteopenia vs osteoporosis
decreases in bone mineral density- t score?
osteoporosis: T score < -2.5
osteopenia: T score -1 to -2.5
peak bone mass should be reached by 30yoa and is determined by
80% genetics
others: weight bearing exercise, nutrition, body mass, hormones
primary vs secondary osteoporosis
primary: gradual and natural bone loss with aging and post menopause estrogen deficient
secondary: from other disease (i.e. anorexia, hyperthyroidism, hypogonadism, hyperparathyroidism) or medications (i.e. glucocorticoids, PPIs, chemo)
3 most common low impact fragility fractures from osteoporosis
vertebrate, hip (femoral neck), wrists
–> fall from standing or lower height; excludes major trauma
which race is most osteopenic
asian
major and minor risk factors for osteoprorosis
age >65
low BMD
white asian or hispanic
personal history of fracture
family history of osteoporosis
glucocorticoids >3months
malabsorption syndrome
hyperparathyroid
hypogonad
early menopasue (before 45)
minor:
RA
hyperthyroid
low diet Ca2+
smoking
alcohol
caffeine
weight <57kg
heparin therapy
aromatase inhibtiros
strongest risk factor for fracture
low BMD
medications increase fracture risk
PPIs
anticoagulatns
aromatase inhibitors
chemo
corticosteroids
loop diuretics
SSRIs
etc
symptoms of osteoporosis
asymptomatic until late stages
-loss of height, kyphosis
Accuracy of Physical Exam Findings for
Diagnosis of Osteoporosis
weight <51kg LR+ 7.3
tooth <20 LR+ 3.4
humped back LR+ 3
wall occiput >0cm LR+4.6
rib pelvis distance <2fingers LR+ 3.8
armspan height difference >5cm LR+1.6
dx of osteoporosis
BMD via DXA
indication to measure BMD for adults <50yoa
- Fragility fracture
- Prolonged use of glucocorticoids
- Use of other high-risk medications
- Fragility fracture after age 40 years
- Hypogonadism or premature
menopause (age < 45 years) - Malabsorption syndrome
- Primary hyperparathyroidism
- Other disorders strongly associated
with rapid bone loss and/or fractur
indication for BMD if >50yoa
- Age ≥ 65 years (both men and women)
- Clinical risk factors for fracture (menopausal women, men aged 50-64 years)
- Fragility fracture after age 40 years
- Prolonged use of glucocorticoids
- Use of other high-risk medications
- Parental hip fracture
- Vertebral fracture or osteopenia identified on
radiography - Current smoking
- High alcohol intake
- Low body weight (< 60 kg) or major weight loss
(>10% of body weight at age 25 years) - Rheumatoid arthritis
- Other disorders strongly associated with
osteoporosis
DXA scan for which areas
Lumbar spine (L2-L4), hip (femoral neck, trochanters, intertrochanteric
regions), wrist are routinely included in scan
T score and Z score in a DXA scan
T score: standard deviations between patient BMD and mean value of MD of healthy, young, attached controls of same sex at peak bone mass (30yoa)
z score: standard deviation between patient BMD and mean value of BMD of healthy age matched control
z= AGE matched
T scores for BMD
- Normal BMD: T-score between +2.5 and -1.0
- Osteopenia: T-score between -1.0 and -2.5
- Osteoporosis: T-score at or below -2.5
- Severe osteoporosis: T-score at or below -2.5 with one or
more fragility fractures
Z score for BMD
- Z-score below -1.5 warrants a comprehensive secondary
osteoporosis workup
fracture risk assessment tool (FRAX)
predict an individual’s 10-year risk of sustaining a hip or other
major osteoporotic fracture (fragility fracture of spine, wrist,
forearm or humerus)
for 40-90yr olds not on pharmacotherapy for osteoporosis
FRAX uses what risk factors
Combines clinical risk factors (age, sex, BMI, ethnicity, prior fractures,
parental hip fracture history, smoking, alcohol use, glucocorticoid use,
rheumatoid arthritis, secondary osteoporosis) and femoral neck BMD T-
score to calculate the 10-year fracture risk
Osteoporosis Self-Assessment Tool
(OST)
- Identifies individuals more likely to have low BMD
- High risk for osteoporosis: score of <2
via =[weight (kg) - age] x 2
CAROC (Canadian Association of
Radiologists and Osteoporosis Canada) Risk
Assessment Tool
Uses bone density (femoral neck T-score) and age to predict 10-year
fragility fracture risk
move up to 1 higher catgoery if hd a fragility fracture or corticosteroid use
high risk category for CAROC
Two fragility fractures at a site other than hip or spine or fracture plus
corticosteroid therapy
CAROC is based on
age, T score
then increase risk if History of fragility
fracture or prolonged
systemic glucocorticoid
Male Osteoporosis Risk Estimation Score
(MORES)
refer for DXA if score >6
age<55 = 0
age 56-74= 3
age >75= 4
COPD= 3
weight <70kg = 6
weight 70-80kg = 4
weight >176lbs= 0
