Osteoporosis

Question 1

Define Osteoporosis

Answer 1

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

Question 2

Aetiology of Osteoporosis

Answer 2

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

Question 3

Risk factors for Osteoporosis

Answer 3

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

Question 4

Symptoms of Osteoporosis

Answer 4

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)

Question 5

Signs of Osteoporosis on examination

Answer 5

Kyphosis
Impaired gait, imbalance and lower-extremity weakness
Vertebral tenderness, esp. on percussion

Severe pain with leg shortened and externally rotate (NOF fracture)

Question 6

Investigations for Osteoporosis

Answer 6

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