28 Questions
What is the most common location for osteoporotic fractures?
Vertebral
Which age group has a mortality rate as high as 58% within a year following osteoporotic fractures?
65 and above
Approximately what percentage of people over 80 will fall each year?
50%
What is a common mediating factor that can contribute to falls in the elderly?
Positional change
Which phase of Paget Disease is characterized by bone formation exceeding resorption?
Sclerotic Phase
What is the common age of onset for Paget Disease?
Between 55 and 65
Which lab test is typically abnormal in patients with Paget Disease?
Elevated alkaline phosphatase
Which imaging finding is characteristic of Paget Disease?
Mix of lytic lesions with bone thickening
What is the main cause of Osteomalacia in adults?
Vitamin D deficiency
Which factor is NOT listed as a common cause of Osteomalacia and Rickets?
Elevated serum calcium
Which lifestyle factor is NOT a known risk factor for osteoporosis?
High Calcium Intake
What imaging technique is commonly used to estimate bone mineral density in osteoporosis?
DEXA Scan
Based on the diagnostic criteria, what T score range is indicative of osteopenia?
-1.0 to -2.4
What tool estimates the 10-year risk of hip and major osteoporotic fracture?
FRAX Score
Which test can be used for assessing balance in fall prevention?
Berg balance test
What type of interventions are recommended for fall prevention in osteoporosis?
Multifactorial interventions
What is a common tool used for assessing mobility in fall risk evaluations?
POMA
Which condition is characterized by weakened and misshapen bones due to excessive bone resorption and haphazard bone growth?
Osteitis deformans (Paget disease)
What is the umbrella term for conditions causing generalized changes in bone density that affect bone integrity?
Metabolic Bone Disease
Which condition is characterized by decreased bone density and puts individuals at risk of fractures?
Osteoporosis
Which tool is used for fracture risk assessment, and can be useful to determine if a patient need a DXA scan?
Fracture Risk Assessment Tool (FRAX)
What is the primary hormone responsible for decreasing calcium excretion in the kidneys in response to low blood calcium levels?
Parathyroid hormone
Which factor contributes most to the risk of developing osteoporosis in post-menopausal Caucasian women?
Smoking
Which condition is most likely to be asymptomatic in patients with findings often discovered incidentally?
Osteoporosis
In which group of patients is osteomalacia most commonly seen?
Underdeveloped countries
Which test is specifically used for diagnosing osteoporosis based on bone mass density comparison?
T score comparison
What is a common risk factor for the development of osteoporosis and osteopenia?
Chronic PPI use
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?
9.3
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
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.
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