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?
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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.