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Questions and Answers
What is the most common location for osteoporotic fractures?
What is the most common location for osteoporotic fractures?
Which age group has a mortality rate as high as 58% within a year following osteoporotic fractures?
Which age group has a mortality rate as high as 58% within a year following osteoporotic fractures?
Approximately what percentage of people over 80 will fall each year?
Approximately what percentage of people over 80 will fall each year?
What is a common mediating factor that can contribute to falls in the elderly?
What is a common mediating factor that can contribute to falls in the elderly?
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Which phase of Paget Disease is characterized by bone formation exceeding resorption?
Which phase of Paget Disease is characterized by bone formation exceeding resorption?
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What is the common age of onset for Paget Disease?
What is the common age of onset for Paget Disease?
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Which lab test is typically abnormal in patients with Paget Disease?
Which lab test is typically abnormal in patients with Paget Disease?
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Which imaging finding is characteristic of Paget Disease?
Which imaging finding is characteristic of Paget Disease?
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What is the main cause of Osteomalacia in adults?
What is the main cause of Osteomalacia in adults?
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Which factor is NOT listed as a common cause of Osteomalacia and Rickets?
Which factor is NOT listed as a common cause of Osteomalacia and Rickets?
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Which lifestyle factor is NOT a known risk factor for osteoporosis?
Which lifestyle factor is NOT a known risk factor for osteoporosis?
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What imaging technique is commonly used to estimate bone mineral density in osteoporosis?
What imaging technique is commonly used to estimate bone mineral density in osteoporosis?
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Based on the diagnostic criteria, what T score range is indicative of osteopenia?
Based on the diagnostic criteria, what T score range is indicative of osteopenia?
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What tool estimates the 10-year risk of hip and major osteoporotic fracture?
What tool estimates the 10-year risk of hip and major osteoporotic fracture?
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Which test can be used for assessing balance in fall prevention?
Which test can be used for assessing balance in fall prevention?
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What type of interventions are recommended for fall prevention in osteoporosis?
What type of interventions are recommended for fall prevention in osteoporosis?
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What is a common tool used for assessing mobility in fall risk evaluations?
What is a common tool used for assessing mobility in fall risk evaluations?
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Which condition is characterized by weakened and misshapen bones due to excessive bone resorption and haphazard bone growth?
Which condition is characterized by weakened and misshapen bones due to excessive bone resorption and haphazard bone growth?
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What is the umbrella term for conditions causing generalized changes in bone density that affect bone integrity?
What is the umbrella term for conditions causing generalized changes in bone density that affect bone integrity?
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Which condition is characterized by decreased bone density and puts individuals at risk of fractures?
Which condition is characterized by decreased bone density and puts individuals at risk of fractures?
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Which tool is used for fracture risk assessment, and can be useful to determine if a patient need a DXA scan?
Which tool is used for fracture risk assessment, and can be useful to determine if a patient need a DXA scan?
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What is the primary hormone responsible for decreasing calcium excretion in the kidneys in response to low blood calcium levels?
What is the primary hormone responsible for decreasing calcium excretion in the kidneys in response to low blood calcium levels?
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Which factor contributes most to the risk of developing osteoporosis in post-menopausal Caucasian women?
Which factor contributes most to the risk of developing osteoporosis in post-menopausal Caucasian women?
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Which condition is most likely to be asymptomatic in patients with findings often discovered incidentally?
Which condition is most likely to be asymptomatic in patients with findings often discovered incidentally?
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In which group of patients is osteomalacia most commonly seen?
In which group of patients is osteomalacia most commonly seen?
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Which test is specifically used for diagnosing osteoporosis based on bone mass density comparison?
Which test is specifically used for diagnosing osteoporosis based on bone mass density comparison?
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What is a common risk factor for the development of osteoporosis and osteopenia?
What is a common risk factor for the development of osteoporosis and osteopenia?
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According to the USPSTF, women 65 and up should be screened for osteoporosis via DEXA scan (grade B). Post-menopausal women at increased risk under the age of 65 at increased risk using FRAX should also have a DEXA scan. What is the threshold via FRAX for getting a DEXA scan?
According to the USPSTF, women 65 and up should be screened for osteoporosis via DEXA scan (grade B). Post-menopausal women at increased risk under the age of 65 at increased risk using FRAX should also have a DEXA scan. What is the threshold via FRAX for getting a DEXA scan?
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Study Notes
Metabolic Bone Disease
- Umbrella term for group of conditions causing generalized changes in bone density that affects bone integrity
- Includes decreased bone density (osteoporosis, osteopenia, rickets, osteomalacia) and increased bone density (Paget disease, osteopetrosis)
Osteitis Deformans (Paget Disease)
- Aggressive demineralization (lytic phase)
- Rapid proliferation of new bone (mixed phase)
- Bone formation exceeds resorption (sclerotic phase)
- Epidemiology: common in aging bones (2.3-9%), onset typically after age 55, slight male predominance
- Clinical presentation: most often asymptomatic, but may present with pain and visible bone deformity
- Predilection for skull, T & L spines, pelvis, and long bones on lower extremities
Osteomalacia & Rickets
- Softening of the bones caused by defective mineralization
- Adults: osteomalacia, kids: rickets
- Epidemiology: rare in developed countries
- Etiology: most commonly caused by deficiencies in Vitamin D, Calcium, and/or Phosphorus
- Common causes of deficiency:
- Vitamin D: inadequate sun exposure, inadequate dietary intake, malnutrition, obesity, pregnancy, certain drugs
- Calcium: inadequate dietary intake, renal failure, hyperparathyroidism, malabsorption
- Phosphorus: genetic disorders, tumor-induced, intestinal malabsorption, alcoholism
Osteomalacia (Adults)
- Clinical presentation: bone pain, bone tenderness, fracture, gait disturbances, muscle spasms, and other signs of hypocalcemia
- May present as osteopenia on imaging
Rickets (Kids)
- Clinical presentation: delayed closure of fontanelles, parietal and frontal bossing, soft skull bones, enlargement of costochondral junction, Harrison sulcus, bowing of distal radius and ulna, femur, and tibia
Osteoporosis & Osteopenia
- Low bone mass, microarchitectural disruption, and skeletal fragility causing decreased bone strength and increased risk of fracture
- Epidemiology: most common in post-menopausal Caucasian women
- Risk factors:
- Lifestyle: smoking, EtOH use disorder
- Drugs: chronic PPI and steroid use, Depo Provera
- Hormones: Testosterone deficiency (men), estrogen deficiency (women), hyperparathyroidism, Cushing's, hyperthyroidism
- Nutritional: Vitamin D deficiency, Calcium deficiency
- Clinical presentation: no "classic symptoms", incidental finding on imaging or identified on screening
- Diagnosis: Dual-Energy X-ray Absorptiometry (DXA) scan
DXA Scan
- Estimates bone mineral density using both low and high-energy photons
- Results are reported as "T scores" and/or "Z scores"
- T score: BMD of the patient compared to a young adult of the same ethnicity and sex
- Z score: BMD of the patient compared to an age-matched reference population of the same ethnicity and sex
- Diagnostic criteria: osteoporosis - T score ≥ -2.5, osteopenia - T score -1.0 to -2.4
Fracture Risk Assessment
- Fracture Risk Assessment Tool (FRAX) estimates 10-year risk of hip and major osteoporotic fracture in patients 40-90 years old
- Several different clinical assessment tools for osteoporotic fracture risk, including FRAX, SCORE, OSIRIS, ORAI, and OST
Fall Prevention
- Screening: Medicare wellness visits, fall risk assessment tools
- Physical exam: "Up and Go" test, Performance-Oriented Mobility Assessment (POMA), chair stand, Berg balance test
- Multifactorial interventions: exercise, targeted physical therapy, manage postural hypotension, manage foot problems, ensure proper footwear, treat vision impairment, home and environmental safety
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Description
This quiz focuses on defining metabolic bone disease and reviewing the physiology of bone formation and metabolism. It also compares and contrasts the pathophysiology, epidemiology, risk factors, clinical presentation, and diagnosis of common metabolic bone disorders. Topics include osteopenia, osteoporosis, rickets, osteomalacia, and Paget disease.
