Bone Mineral Density (BMD): Function of both peak bone mass and how much is lost
- Peak bone mass @ 21
- Peak bone mass obtained by age 30
T- Score: Current BMD compared to mean peak BMD of normal. Negative in late peri or postmenopausal women
Normal T score > or = to -1.0
Low (Osteopenia) T score between -1.0 and -2.5
Osteoporosis T score < or = - 2.5
Z- Score: For premenopausal women, 26 yr old triathlete- want Z score
Osteoporosis
Primary: Occurs with age
Secondary: Result of meds or disease
- Steroids (Prednisone)
- Thyroid
- Deficient estrogen
Management Osteoporosis
- Slowing/stopping bone loss
- Increasing bone mass or improving bone architecture
- Maintain or increase bone strength
- Minimize fall factors
Patho
Osteoclast- removes bone tissue. Promote bone resorption (cells that help eat away at old one0
Osteoblast- building. Promote bone formation.
Menopause- rapid bone loss r/t estrogen-mediated inhibition. During menopause because of decrease in estrogen, not getting bone formation at same rate due to blasts.
Risk Factors
- Age, genetics, lifestyle factors - low calcium and vitamin D, thin (low body weight 154 lb), menopause, meds (glucocorticoids and steroids)
Hx falls, fainting, or
loss of consciousness
Muscle
weakness
Dizziness,
coordination, or balance problems
Difficulty standing or walking
Arthritis of lower extremities
Neuropathy of lower extremities
Impaired vision
medications
Book includes: cig smoking, familh hx, lifetime decreased calcium intake, white, asian
History
- Symptoms acute or chronic back pain
- Height, calculate BMI
- Vertebral fracture present: Loss >1.5 inches, kyphosis
Percussion tenderness with vertebral fracture
Patient Teaching
- Age 60-65 discuss fall prevention
- Core strengthening, balance
Indications BMD Testing
- If possible, do baseline at menopause
- Women age > 65
- Postmenopause with condition causing bone loss (Steroid use, hyperparathyroidism)
- Postmenopause, age > 50 with Risk factors: Fracture
after menopause, Thinness, Hx of hip fx in a parent, Current
smoker, Rheumatoid
arthritis, Alcohol of more than 2 units/day
- Postmenopause women with fragility fx
