Osteoporosis

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Alli Castagno & Christy Kaiser  from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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Definition/Description

Osteoporosis, literally meaning porous bones, is a decrease in bone mass and damage to the bone structure. The combination of the two causes bones to be more susceptible to fracture. There are two types; primary and secondary osteoporosis. Primary osteoporosis is unrelated to other disease or condition, and is the more common of the two. It is most common in women post menopause or older men, but can occur to either gender at all ages. Some types of primary osteoporosis are idiopathic osteoporosis, postmenopausal osteoporosis, and senile or involutional osteoporosis. Secondary osteoporosis occurs as a side effect of medication or secondary to another condition or disease. Osteopenia is the condition of low bone mass. This is often a precursor to osteoporosis. Low bone density, frequently reported as T-scores, is often used to classify individuals as osteoporotic. According to the World Health Organization, a normal bone mineral density score is -1.0 or higher, -1.0 to -2.5 for osteopenia, and -2.5 or lower for osteoporosis.

Prevalence

Osteoporosis is the most prevalent bone disease in the world. According to the National Osteoporosis Foundation, about 10 million Americans currently have osteoporosis, while about 34 million are at risk for the disease. It is estimated that one in two women over the age of 50 and one in four men will break a bone because of osteoporosis. It is projected that by 2020, half of Americans over the age of 50 will have osteoporosis or low bone density.

Characteristics/Clinical Presentation

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Associated Co-morbidities

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Medications

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Diagnostic Tests/Lab Tests/Lab Values

In order to make a diagnosis of osteoporosis there are series of diagnostic tests and lab tests that your doctor may perform after taking a thorough patient history and performing an examination.

Bone Density Test

The most common test used is a bone density test, which is the only test that can detect osteoporosis before a fracture occurs. There are two types of bone density tests: Central DXA and Screening Tests. Central DXA uses a dual energy absorptiometry machine to test the bone density of the hip and spine. If testing can’t be done to the hip and spine then it is recommended to test the radius of the forearm. Central DXA is the preferred method because it measures bone density at the hip and spine where bone loss occurs most rapidly.

Screening Tests, also called peripheral tests, measure bone density in the lower arm, wrist, finger, or heel. These are useful when Central DXA testing is not possible. Screening tests cannot accurately diagnose osteoporosis or measure how well medication is working.

Bone density test results are reported using T-scores. T-scores are relative to how much higher or lower your bone density is compared to that of a healthy 30 year old adult.

Category	T-score
Normal	-1.0 or above
Osteopenia (low bone mass)	-1.0 to -2.5
Osteoporosis	-2.5 or less
Severe Osteoporosis	-2.5 or less with one or more fragility fractures

Laboratory Tests

- Blood Calcium levels
- 24-hour urine calcium measurement
- Thyroid function tests
- Parathyroid hormone levels
- Testosterone levels in men
- 25-hydroxyvitamin D test to determine whether the body has enough vitamin D
- Biochemical marker tests, such as NTX and CTX

Some of these tests can help to identify if you have any other medical conditions that could contribute to osteoporosis, which would be called secondary osteoporosis. Biochemical marker tests can help estimate how fast you are losing or making bone.

Etiology/Causes

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Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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References

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