Osteoporosis

Question 1

Define:

Answer 1

Reduced bone density of >2.5 than the T score.

THIS IS REDUCED BONE MASS.

Question 2

Aetiology:

Answer 2

Primary - if <50 years –> idiopathic + post menopause

Secondary - ME DR G

• Malignancy - myleoma and metastatic carcinoma
• Endocrine -Cushing’s disease, Thyrotoxicosis Primary hyperparathyroidism, Hypogonadism

Drugs - corticosteroids, heparin

Rheumatological - rheumatoid arthritis, ankylosing spondylitis

Gastrointestinal:
• Malabsorption (e.g. coeliac disease, partial gastrectomy)
• Liver disease (e.g. primary biliary cirrhosis)
• Anorexia

Question 3

Risk factors:

Answer 3

SHATTERED

Smoking/steroid use

Hyperparathyroidosis/calcuria and thyroidism

Alcohol/age

Thin (BMI<22) - or lack of exercise

Testosterone low

Early menopause/ late menarche

Renal or liver failure

Erosive/ inflammatory bone disorders

Dietary deficiency of calcium and malabsorption

Question 4

Symptoms:

Answer 4

Usually none till there are fractures

Common fracture sites:

• Colle’s fracture
• Neck of the femur
• Vertebral fractures

Question 5

Signs:

Answer 5

Usually none till there are fractures.

Bone tenderness on percussion

Thoracic Kyphosis

Severe pain when hip is flexed and internally rotated

Question 6

Epidemiology:

Answer 6

Common

If <50 yrs:
1/3 women
1/12 men

More common in caucasians than Afro-Caribbean

Question 7

Investigations:

Answer 7

Bloods:
-Calcium, ALP and phosphate = NORMAL

X-ray:

• will not show anything until there is >30% loss
• Biconcave vertebrae
• Crush fractures

Isotope bone scans

DEXA SCAN

Question 8

What is the difference between a Z score and a T score?

Answer 8

T score is how many standard deviations the bone mineral density is above or below a young normal mean bone density.

Z score is how many standard deviations the bone mineral density above or below than an age matched mean bone density.