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22 Cards in this Set
- Front
- Back
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Osteoporosis Definition
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A metabolic bone disorder characterized by low bone mass and micro-architectural deterioration leading to increased bone fragility and susceptibility to fracture
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Primary Osteoporosis
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Age-related
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Secondary Osteoporosis
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Caused by disease or medications
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Gold Standard Bone densitometry
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DEXA (Dual energy x-ray absorbitometry)
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The 2 Unknowns in DEXA
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Soft tissue attenuation
Bone Mineral Density |
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Measurement unit of BMD
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g/cm^2 (2D measurement which is not true density)
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T Score and use
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Number or standard deviations above or below the mean BMD of a healthy 30 year old adult (sex specific)
Used for those above age 50 |
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Z Score and use
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Number of standard deviations above or below the mean BMD for the person's age (sex specific)
Used for those below age 50 |
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BMD reaches natural peak around age ____ and stays stable for approximately _____ years
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25
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After age ____ BMD decreases by _____% per year and faster for post-menopausal women
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35
0.3-0.5 |
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Fragility Fracture Definition, exclusions
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a fracture that occurs
spontaneously or after minor trauma such as a fall from standing height or less, excluding craniofacial, hand, ankle, and foot fractures. |
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Stress Fracture
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results from repetitive low
impact trauma. Normal bone density. |
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Pathologic Fracture
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Results from metastatic deposit in bone
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CAROC acronym, risk levels, Factors, and modifiers
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Canadian association of radiologists and osteoporosis Canada
Low, medium, high Age Gender T-score for femoral neck only Up one level for previous fragility fracture Up one level for steroid use Fragility fracture of hip or spine --> automatically high Multiple fragility fractures --> automatically high |
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Indications for DEXA > age 65
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All men and women
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Indications for DEXA between 50-65 (8)
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Fragility fracture after age 40
Prolonged use of glucocorticoids or other high risk Rx Vertebral fracture Known osteopenia High alcohol intake Current smoking less than 60 kg or 10% weight loss from age 25 Other disorders strongly associated with osteoporosis |
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Indications for DEXA below age 50 (7)
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Fragility fractures
High risk meds Hypogonadism Malabsorption syndromes Chronic inflammatory conditions Primary hyperparathyroidism Other disorders associated with rapid bone loss and fractures |
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Low risk, next step
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< 10% risk of fracture in 10 years
Reassess in 5 years |
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Medium Risk, next step (1), then (1)
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10-20% risk of fracture in 10 years
Lateral thorocolumbar radiography Assess for indicators for pharmacotherapy |
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High risk, then
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> 20% risk of fracture in 10 years, or fragility fracture of hip or spine, or multiple fragility fractures
Offer pharmacotherapy |
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Indicators for medium risk pharmacotherapy (10)
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Additional vertebral fractures
Previous wrist fracture in those >65 Lumbar spine T score below Femoral neck T score Rapid bone loss Men undergoing androgen deprivation therapy Women undergoing aromatase inhibitor therapy for breast cancer Long term or repeated use of steroids 3+ falls in the last year Other |
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Factors modifying BMD (10)
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Vertebral fractures
Kidney Stones Gall stones Vascular calcification Contrast material Rotation (scoliosis) Bone lesions Insufficient rotation of the hip Osteoarthritis Artifacts |
