Questions and Answers
What is primary osteoporosis?
Postmenopausal, age-related, idiopathic (men)
What is secondary osteoporosis?
Disease or drug related
How does menopause affect bone loss?
Decrease in estrogen increases osteoclast activity, lose 10-25% in 1st decade after menopause and 8-12% each decade after.
What type of bone is most affected by postmenopausal osteoporosis?
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What causes age-related osteoporosis?
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What type of bone is most affected by age-related osteoporosis?
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Why is osteoporosis less common in men?
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Who should be evaluated for osteoporosis risk?
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What risk factors are accounted for in the FRAX tool?
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What are the symptoms of osteoporosis?
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What are the signs of osteoporosis?
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What are common secondary causes of osteoporosis: disease states?
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What are common secondary causes of osteoporosis: major medication?
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What are the types of peripheral bone density testing?
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What is peripheral bone density testing used for?
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Who should be screened with QUS?
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What is central bone density testing?
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Why is central DXA the gold standard?
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What is central DXA used for?
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What are the indications for central bone mineral density testing?
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When is central DXA performed?
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What is a T-score?
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What is a Z-score?
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When is T-score used? When is Z-score used?
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What is a normal T-score?
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What is an osteopenia T-score?
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What is an osteoporosis T-score?
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What is a severe or established osteoporosis T-score?
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What is the normal Z-score?
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What is a low Z-score?
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Study Notes
Osteoporosis Overview
- Primary osteoporosis types include postmenopausal, age-related, and idiopathic (in men).
- Secondary osteoporosis occurs due to diseases or medication.
Menopause and Bone Health
- Estrogen decrease during menopause increases osteoclast activity, causing significant bone loss (10-25% in the first decade, 8-12% each subsequent decade).
- Trabecular bone is primarily affected by postmenopausal osteoporosis.
Age-Related Osteoporosis
- Age-related osteoporosis is characterized by decreased calcium absorption, reduced sex hormones, and decreased osteocyte activity.
- Both cortical and trabecular bones are equally affected by age-related osteoporosis.
Gender Differences
- Osteoporosis is less common in men due to higher peak bone mass, larger bone size, the absence of menopause, shorter life expectancy, and lower fall risk.
Evaluation and Screening
- All individuals over 50, both men and women, should be evaluated for osteoporosis risk.
- The FRAX tool assesses risk factors like age, gender, previous fractures, body mass index (BMI), rheumatoid arthritis, and parental history of hip fractures.
Symptoms and Signs
- Osteoporosis may be asymptomatic; subtle low back pain might indicate vertebral fractures.
- Signs include loss of height greater than 1.5 inches, kyphosis, low bone density on X-rays, and low-trauma fractures.
Common Secondary Causes
- Disease states contributing to osteoporosis include insulin-dependent diabetes, thyrotoxicosis, rheumatoid arthritis, hypogonadism, and chronic liver or kidney diseases.
- Major medication contributing to secondary osteoporosis primarily involves glucocorticoids.
Bone Density Testing
- Peripheral bone density testing methods include quantitative ultrasound of the heel and peripheral DXA.
- This testing is useful for screening and fracture risk assessment but not for diagnosis or monitoring.
Central Bone Density Testing
- Central testing involves dual energy X-ray absorptiometry (DXA) and is the gold standard due to high precision, short scan time, low radiation, and best fracture risk prediction.
- Central DXA is used for diagnosis and monitoring response to drug therapy.
Indications for Central DXA
- Recommended for women over 65, men over 70, postmenopausal women and men aged 50-69 with risk factors, adults over 50 with fractures, and adults with conditions associated with bone loss.
- Central DXA is performed at diagnosis and every two years post-treatment initiation.
T-Scores and Z-Scores
- T-score: number of standard deviations (SD) above or below the mean bone mineral density (BMD) for healthy, sex-matched young adults.
- Z-score: number of SD away from mean BMD for an age, sex, and race-matched population.
- T-scores are used for diagnosing primary osteoporosis; Z-scores apply to secondary osteoporosis.
- Normal T-score is above -1; osteopenia is between -1 to -2.5; osteoporosis is below -2.5; severe osteoporosis includes a fracture with a T-score under -2.5.
- Normal Z-score is above -2; a low Z-score is below -2.
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Description
Test your knowledge on osteoporosis with this quiz that covers the classification of primary and secondary osteoporosis, the impact of menopause on bone health, and more. Understand the differences and implications for individuals suffering from this condition.