Screening for Metabolic MSK Disease PDF

Here is the converted markdown format of the document. # Screening for MSK Metabolic Disease ## Pathophysiology-MSK Metabolic Disorders * Gout * excessive uric acids; Joint pain and swelling; fever and chills; joint redness * Metabolic Bone Disease * Osteoporosis – decrease bone ma...

Here is the converted markdown format of the document. # Screening for MSK Metabolic Disease ## Pathophysiology-MSK Metabolic Disorders * Gout * excessive uric acids; Joint pain and swelling; fever and chills; joint redness * Metabolic Bone Disease * Osteoporosis – decrease bone mass; pain; fractures, kyphosis, Dowager's. * Osteo-malacia – softening of bones; bone pain; fractures, deformities, myalgia (see later slide). * Paget's Disease -Next slide..... ## Metabolic Bone Disease * Risk Factors * Caucasian and Asian women * Age > 65 * Early menopause * Family hx * S & S of osteoporosis * Back pain, fracture, decrease of > 1 inch in height, kyphosis, dowager's hump, early satiety ## Osteoporosis Screening * Screening Evaluation * In you BB materials- yes/no questions to assess risk ## Imaging for Osteoarthritis Modified from ACR Appropriateness Criteria | | Imaging Usually Appropriate | Imaging May Be Appropriate | | :---------------------- | :--------------------------------------------------------- | :------------------------- | | 1. Initial imaging | Radiograph – hip Radiograph - pelvis | | | 2. Radiographs positive/ equivocal for mild osteoarthritis; evaluating for cartilage integrity | MR arthrography hip MR with / without contrast | CT Arthrography hip | ## Suspected Osteoporosis | | Imaging Usually Appropriate | Imaging May be Appropriate | | :---------------------- | :-------------------------- | :----------------------------------------------------------------------------------------------------- | | 1. Initial screening | DXA lumbar spine and hips | Quantitative CT lumbar spine & hips | | 2. Follow-up risk factors present, or known low density | DXA lumbar spine and hips | Quantitative CT lumbar spine & hips Trabecular bone score | | 3. Follow-up, significant risk factors present | DXA lumbar spine and hips DXA vertebral fracture assessment | Quantitative CT lumbar spine & hips Radiography axial skeleton | ## Other metabolic bone diseases * Osteomalacia- softening of bones from Vit D deficiency * S & S: Bone pain, skeletal deformity, fracture, severe muscle weakness, myalgia * Paget's AKA Osteitis Deformans: * produces disordered bone remodeling secondary to inflammation. The new bone is larger and less dense. * S&S:, fractures & deformity; * S & S: bone pain, stiffness, fractures & deformity, muscle weakness & fatigue, bowing of Les, head enlargement, OA, large clavicles The image is a radiograph of a hip of an individual with osteomalacia (insufficient mineralization) where the trabeculae of the head and neck are largely missing. Osteomalacia is a metabolic disease characterized by soft bones usually from vitamin D deficiency or phosphate disorder. ## When to Refer? * Diabetic with confusion, lethargy, profuse diaphoresis, or signs of DKA * Episodes of hypoglycemia * Signs of potassium depletion – muscle weakness, cramping, fatigue * Unexplained fevers * Palpable nodules or masses * Signs of fluid loss or dehydration * Recurrent arthritic symptoms in a client with gout