Snapshot A 67-year-old woman presents to the emergency department after falling while walking down the stairs of her home. She landed on her rear on a carpeted floor and denies hitting her head. She experienced severe pain in her right hip after the fall and is unable to bear weight on the affected side. Menopause began 17 years ago. She has smoked 1-pack of cigarettes for the past 40 years. On physical exam, her right leg is shortened, adducted, and externally rotated. Laboratory testing is unremarkable. Introduction Clinical definition decreased bone mass (osteopenia) that significantly increases the patient's risk of fracture Epidemiology Incidence most common types of osteoporosis are post-menopausal senile Risk factors post-menopausal women being ≥ 65 years of age people of Caucasian and Asian descent lifestyle factors such as poor physical activity vitamin D deficiency and poor calcium intake smoking alcohol use disorder medications such as warfarin, lithium, proton pump inhibitors, and glucocorticoids hyperparathyroidism hyperthyroidism multiple myeloma malabsorption syndromes Etiology Pathogenesis in young adulthood, peak bone mass is achieved and this is determined by a number of factors (e.g., genetics) after this peak bone mass is attained, there is a small decrease in bone formation with every cycle of bone remodeling senile osteoporosis osteoblasts have their biosynthetic and proliferative ability reduced with age poor physical activity mechanical force on bone stimulates bone remodeling athletes have increased bone density decreased physical activity results in bone loss decreased estrogen levels such as in menopause, decreased estrogen levels increase bone resportion and formation however, the rate of formation is less than resorption resulting in a net bone loss increased osteoclast activity is significant in areas of bone with large surface area such as the vertebral bodies, leading to vertebral compression fractures there is trabecular and cortical bone loss Presentation Symptoms fractures (e.g., vertberal and hip), otherwise, patients are typically asymptomatic Physical exam may see loss in height Imaging DEXA indication all women ≥ 65 and all men ≥ 70 years of age smoking and sedentary lifestyles are risk factors notes T-score ≤ -2.5 Studies Labs serum calcium, phosphorus, parathyroid hormone, and alkaline phosphatase are normal Histology histologically normal; however, there is a decreased quantity of normal bone Differential Laboratory Abnormalities in Select Bone DisordersEtiologySerum PhosphateSerum CalciumSerum Alkaline PhosphataseParathyroid HormoneOsteomalacia / ricketsDecreasedDecreasedIncreasedIncreasedOsteoporosisNormalNormalNormalNormalOsteopetrosisNormalNormal or decreasedNormalNormalPaget disease of the boneNormalNormalElevatedNormalOsteitis fibrosa cysticaPrimary•hyperparathyroidism- decreasedSecondary•hyperparathyroidismincreasedPrimary•hyperparathyroidismincreasedSecondary•hyperparathyroidismdecreasedPrimary and secondary hyperparathyroidism increasedPrimary and secondary hyperparathyroidism increasedHypervitaminosis DIncreasedIncreasedNormalDecreased Treatment Conservative calcium and vitamin D supplementation strength training smoking cessation Medical bisphosphonates indication first-line for pharmacologic therapy in osteoporosis raloxifene second line therapy for osteoporosis can cause hot flashes and venous thromboembolism does not cause endometrial hyperplasia or increase risk of breast cancer teriparatide indication considered first-line in patients with a very high risk of fracture Complications Fractures Prognosis Generally good if detected early and appropriately managed
QUESTIONS 1 of 6 1 2 3 4 5 6 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M2.OR.17.4754) A 64-year-old female presents to her primary care physician for an annual checkup. She states that her health is adequate, but she has not been doing well since her husband died last year. She is able to get by but admits to having trouble caring for herself, cooking, cleaning, and paying her bills. The patient complains of diffuse muscle aches and pains. She has a past medical history of anxiety and seasonal affective disorder. She is not currently taking any medications. On physical exam, you note a gaunt woman with a depressed affect. You note that her body mass index (BMI) and height have both decreased since her last annual visit. On physical exam, her cardiac, pulmonary, and abdominal exams are within normal limits. Lab work is drawn and is as follows:Serum:Na+: 135 mEq/LK+: 3.7 mEq/LCl-: 100 mEq/LHCO3-: 23 mEq/LUrea nitrogen: 7 mg/dLGlucose: 70 mg/dLCreatinine: 0.8 mg/dLCa2+: 8.0 mg/dLMg2+: 1.5 mEq/LParathyroid hormone: 855 pg/mLAlkaline phosphatase: 135 U/LPhosphorus: 2.6 mg/dL Hemoglobin: 14 g/dLHematocrit: 36%Platelet count: 187,000/mm^3Leukocyte count: 4,700/mm^3What is the most likely diagnosis? QID: 108976 Type & Select Correct Answer 1 Osteopenia 4% (2/52) 2 Osteoporosis 8% (4/52) 3 Osteomalacia 44% (23/52) 4 Hyperparathyroidism 29% (15/52) 5 Clinical malnutrition 8% (4/52) M 6 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M2.OR.16.37) A 67-year-old Caucasian female presents to her primary care physician after a screening DEXA scan reveals a T-score of -3.0. She smokes 1-2 cigarettes per day. She lifts weights several times a week. Which of the following measures would have reduced this patient's risk of developing osteoporosis? QID: 102978 Type & Select Correct Answer 1 Reduced physical activity to decrease the chance of a fall 0% (0/15) 2 Initiating a swimming exercise program three days per week 60% (9/15) 3 Intranasal calcitonin therapy 0% (0/15) 4 Calcium and vitamin D supplementation 33% (5/15) 5 Weight loss 0% (0/15) M 7 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (M3.OR.15.10) A 47-year-old African-American woman presents to her primary care physician for a general checkup appointment. She works as a middle school teacher and has a 25 pack-year smoking history. She has a body mass index (BMI) of 22 kg/m^2 and is a vegetarian. Her last menstrual period was 1 week ago. Her current medications include oral contraceptive pills. Which of the following is a risk factor for osteoporosis in this patient? QID: 102951 Type & Select Correct Answer 1 Age 0% (0/4) 2 Body mass index 0% (0/4) 3 Estrogen therapy 0% (0/4) 4 Race 0% (0/4) 5 Smoking history 75% (3/4) M 10 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic
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