Osteoporosis Classification and Diagnosis

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?

Trabecular Signup and view all the answers

What causes age-related osteoporosis?

Decreased calcium absorption, decrease in sex hormones, decreased osteocyte activity. Signup and view all the answers

What type of bone is most affected by age-related osteoporosis?

Equal on cortical and trabecular. Signup and view all the answers

Why is osteoporosis less common in men?

Higher peak bone mass, bigger bones, no menopause, shorter life expectancy, lower propensity to fall. Signup and view all the answers

Who should be evaluated for osteoporosis risk?

All men and women over 50 Signup and view all the answers

What risk factors are accounted for in the FRAX tool?

Age, gender, prior fracture, femoral neck BMD, BMI, rheumatoid arthritis, current smoking, secondary osteoporosis, parental history of hip fracture, alcohol use, oral glucocorticoids for more than months (ever). Signup and view all the answers

What are the symptoms of osteoporosis?

Asymptomatic (low bone mass), subtle low back pain (vertebral fracture). Signup and view all the answers

What are the signs of osteoporosis?

Loss of height >1.5 in, kyphosis, low bone density on x-ray, low-trauma fracture. Signup and view all the answers

What are common secondary causes of osteoporosis: disease states?

Insulin-dependent diabetes, thyrotoxicosis, rheumatoid arthritis, hypogonadism, chronic liver or kidney disease. Signup and view all the answers

What are common secondary causes of osteoporosis: major medication?

Glucocorticoids. Signup and view all the answers

What are the types of peripheral bone density testing?

Quantitative ultrasound of heel, peripheral DXA. Signup and view all the answers

What is peripheral bone density testing used for?

Screening, helps with fracture risk assessment (not diagnostic or monitoring). Signup and view all the answers

Who should be screened with QUS?

Postmenopausal women and men over 65 (no guidelines available). Signup and view all the answers

What is central bone density testing?

Dual energy x-ray absorptiometry (DXA). Signup and view all the answers

Why is central DXA the gold standard?

High precision, short scan time, low radiation dose, best predictor of fracture risk. Signup and view all the answers

What is central DXA used for?

Diagnosis and monitoring drug therapy response. Signup and view all the answers

What are the indications for central bone mineral density testing?

Women over 65, men over 70, postmenopausal women and men 50-69 with risk factors, adults with fracture after 50 yr, adults with conditions associated with bone loss. Signup and view all the answers

When is central DXA performed?

Diagnosis, every 2 years after initiation of therapy. Signup and view all the answers

What is a T-score?

Number of standard deviations above or below mean BMD for a healthy, sex-matched, young adult. Signup and view all the answers

What is a Z-score?

Number of standard deviations away from mean BMD for age, sex, and race matched population. Signup and view all the answers

When is T-score used? When is Z-score used?

T = diagnosis for primary causes, Z = secondary osteoporosis. Signup and view all the answers

What is a normal T-score?

Above -1. Signup and view all the answers

What is an osteopenia T-score?

-1 to -2.5. Signup and view all the answers

What is an osteoporosis T-score?

Below -2.5. Signup and view all the answers

What is a severe or established osteoporosis T-score?

Below -2.5 + fracture. Signup and view all the answers

What is the normal Z-score?

Above -2. Signup and view all the answers

What is a low Z-score?

Below -2. Signup and view all the answers

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 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.