| What is T score? | Bone mass, BMD, accounts for 70% of bone strength, used to assess osteopororsis.
Defined as BMDT <-2.5 below the mean peak BMD in young healthy adults of same gender.
Limitations of T score (use of dual energy X ray which is 2D not 3D, not qualitative measures of bone strength not all bone components, fracures may occure with T score higher than -2.5)
Osteopenia between -1 and -2.5 |
| how is dx of OP? | T <-2.5, and/or presence of non-trauma fractures (hip/vertebra), and/or elevated risk of fracture in absolute risk (FRAX tool for example) |
| What is post-menopausal OP? | Estrogen deficiency increases bone turnover reulting in bone loss and structural decay.
Production of cytokines (IL1, IL6, and TNF a) is upregulated which increase lifespan and production of osteoclasts.
RANKL upregulated, while OPG downregulated, accumulation of apoptotic osteocytes within bone increase bone fargility. |
| What is secondary OP? | Endocrine (thyrotoxicosis, hyperpara, Cushing's, T1DM, acromegaly, hypogonadism, hyperPRL, bilateral oophorectomy)
Drugs (glucocorticoids, aromatase inhibitors, GnRH agonists, antidepressants and antiepileptics and PPI)
Hematologic disorder (multiple myeloma, mastocytic hemophilia, thalassemia)
Nutritional/GI (IBD, malabsorption diseases, malnutriton)
Neuro (parkinsons)
Others (RA, AS, COPD, SLE, CKD, immoblisiation, sarcoidosis, amyloidosis, organ transplatn) |
| What is glucocorticoid induced OP? | Most common iatrogenic OP, GC for a period of 3 months, increased risk of OP fractures (proportional to regular GC dose and duration within 3 months of therapy, increased bone loss in first year mostly, associated with even low doses of GCs) |
| How is OP in men? | Lifetime risk of fracutre older than 50 years is 20%, risk in men in 50 for vertebral and 65 years for hip fractures, prevalence is lower than women, andropause occurring at higher age then menopause in women and only in a subpopulation of men. |
| How is osteopototic hip fracture? | Mortality 20%
results from the co-occurrence of several risk factors:genetics, low bone mass, low bone quality, elevated fall risk, co-morbidity and high age |
| How is osteoporotic vertebral fracture? | ● Can occur without trauma
● usually occur during daily activities such as lifting, climbing stairs, bending forward
● Loss of height
● Can be asymptomatic / acute severe pain
● Domino effects |
| What are non-hip non-vertebral OP fractures? | Most common, wrist fracture, risk of recurrence of other fractures. |
| What are bone related risk factors assessed by FRAX? | Prior fragility fracture, parental hx of hip fracture, current tobacco smoking, ever long-term use of GC, RA, other causes of 2ary OP, alcohol consuptions of 3 units or more daily |
| What are S&S of OP? | Silent disease unless fracture occurs, loss of height and increased kyphosis |
| How is dx of OP? | Blood tests (CBC[anemia], serum chem normal in 1ary OP, LFT, TSH, vitamin D deficiency, 24-hour calcium/creatinine hypercalciuria maybe due to malabsorption syndromes, testosterone and LH/FSH male hypogonadism)
BMD (done for women age 65 and men over 70 regardless of risk factors, postmenopausal women and men over 50 if have risk factor/ adult age fracture determine degree of OP, adult with condition or medication) |
| What are risk factors of OP? | Primary (previous fracture after age 30, smoking, underweight, low BMD, family hx of hip fracture)
Secondary (non modifiable white race, advanced age, dementia, poor health. Modifiable low Ca intake, eating disorder, low testosterone, estrogen deficiency, alcohol, physcial inactivity, impaired vision, neuro disorder, lack of sunlight exposure |
