Medical Screening for Osteoporosis Related Fractures

Flashcards on medical screening for osteoporosis related fractures.

Osteoporosis

Compromised bone density often caused by this condition, the most common cause. Also can be caused by bony tumors.

Recognizing Patients at Risk

Collecting patient demographics and health history information is critical to help us determine who's at risk for fracture because it may not always be major trauma.

Osteoporosis Definition

A chronic, progressive disease manifested by low bone mass, impaired bone quality, and decreased bone strength, leading to higher fracture risk.

Primary Osteoporosis

Associated with age related changes, impacting both women and men.

Secondary Osteoporosis

Significant bone density loss due to medications or diagnosed illnesses that interfere with bone formation or accelerate bone density loss.

Osteomalacia

Bone softening.

Osteopenia

Radiographic evidence of low bone mass.

Osteopetrosis

Increased bone density.

Osteoporosis

A systematic disease marked by decreased bone density.

Group at Greatest Risk

Women postmenopausal who are estrogen deficient are at greatest risk, men's fracture risk increases in their mid-seventies and older.

Risk Factors for Compromised Bone Density

Age, race (Caucasian, Asian, Northern European ancestry), low body weight, long durations of immobilization, inactivity, and dietary deficiencies.

Medications Associated with Compromised Bone Density

Corticosteroids, anticoagulants (Heparin, Coumadin), laxatives, methotrexate, benzodiazepines (Valium, Librium, Xanax), proton pump inhibitors, tamoxifen, alcohol intake, tobacco use, caffeine intake (more than three cups of coffee per day).

Diseases Associated with Compromised Bone Density

Hyperthyroidism, Cushing's syndrome, chronic renal failure, type diabetes, GI malabsorption disorders (celiac disease), spinal cord injury, and previous osteoporosis related fracture.

Most Common Osteoporosis Fracture Sites

Vertebral bodies (mid-lower thoracic, upper lumbar spine), proximal femur (hip), ribs, and distal radius.

Age Demographics for Compression Fracture Risk

Women over 65, men mid-seventies, and both women and men greater than age 80.

Comorbidities Increasing Vertebral Compression Fracture Risk

History of osteoporosis (especially with previous fracture), history of corticosteroid use (greater than 5 mg over three months), previous history of cancer, and history of falls.

Symptoms of Vertebral Compression Fractures

Pain in the midline (mid-back, upper lumbar), worsened by trunk flexion, relieved by non-weight-bearing postures and trunk extension.

Onset of Proxofemoral Fractures

Slip without a fall, misstep off a curb, lifting or bending leading to hip or trochanteric pain, worse with weight bearing.

Physical Examination Findings for Proximal Femoral Fractures

Antalgic gait, palpatory pain over the femoral triangle, trochanter, or deep in the buttock region, hip position in abducted and externally rotated position.

Patellar pubic percussion test

The most appropriate special test for patient with suspected proximal femoral fracture, used to assess for significant hip or knee joint pathology.

Onset of Osteoporosis-Related Rib Fractures

Coughing and sneezing, lifting, carrying something heavy leading to rib pain/ side pain, worsened by deep breaths, relieved by avoiding those activities.

Physical Examination Findings for Rib Fractures

Pain on deep breath, palpation over the area, possible use of tuning fork for pain provocation or the bowing/bending test.

Onset of Distal Radius Fractures

Fall on outstretched hand (FOOSH), occasionally a slip without a fall, leading to wrist pain, worsened by lifting or weight bearing.

Physical Examination Findings for Distal Radius Fractures

May be deformity, palpatory pain over the area, loss of range of motion (especially extension or radial deviation), possible use of tuning fork for pain provocation.

Key to Detecting Fracture

Understanding who's at risk for fracture with minor trauma based on patient demographics and health history.

Best Test for Screening a Femoral Neck Fracture

Auscultation with percussion is the best test for deep set areas of skeletal anatomy.