Pages

Thursday, January 15, 2015

A 67 Year Old Post menopausal Woman For Routine Checkup

A 67 year old post menopausal woman comes to the clinic for a routine checkup. She denies any serious symptoms but complains of backache and admits that she has been inactive for last few years after retirement.
The X- rays taken are shown here





What bony abnormality is seen in these X- rays?
.
.
.
Case Discussion:
Osteoporosis:
Osteoporosis is a common metabolic bone disease characterized by osteopenia with normal bone mineralization. Most commonly seen in in active, postmenopausal women.

Clinical Features:
This condition is commonly asymptomatic. Some patients may present with hip fractures, vertebral compression fractures (resulting in loss of height and progressive thoracic kyphosis) , and / or distal radius fracture after minimal trauma.

Differential Diagnosis:

  • Osteomalacia (inadequate bone mineralization)
  • Hyperparathyroidism
  • Multiple myeloma
  • Metastatic cancer

Screening:
All patients above 65 years of age as well as those 40-60 years with at least one risk factor for osteoporotic fractures after menopause should be screened with a dual energy x-ray absorptiometry (DEXA) scan of the hip and the spine.

  • Osteopeneia: T score -1to-2.5
  • Osteoporosis: T score < -2.5
Treatment:
Treatment is required for patients with a T score < -2 or when T score is <-1.5 in a patient with risk for osteoporotic fractures. 
1. Drug of choice with good efficacy is bisposphonates ( alendronate, etidronate )
2. other drugs include selective estrogen receptor modulators (raloxifene) and intranasal calcitonin.
3. Treat the secondary causes if present.
4. Weight bearing exercises and calcium with vitamin D supplements are also helpful.
5. DEXA scan should be repeated 1 to 2 years after starting treatment. 

No comments:

Post a Comment