Osteoporosis Diagnosis Essay

Presentation about osteoporosis with twelve slides in a PowerPoint format with a Reference List in APA format.

Criteria:

1- Presents the case including CC, HPI, Hx, ROS and PE findings concisely

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2- List possible differential diagnosis with supporting/excluding criteria.

3- What labs or tests are typically ordered concerning this condition? What results should the Does NP expect to see with this diagnosis?Osteoporosis Diagnosis Essay

4- What medications are typically prescribed for this condition? List specific drugs, starting doses, dose ranges, precautions to keep in mind when prescribing these drugs.

5- What are the outcomes expected or unexpected for this specific condition? Moreover, What patient outcomes will trigger a referral?

6- Provide patient teaching materials specific to their condition

Men and women over 60-years of age are at higher risk of osteoporosis than younger people. Nevertheless, it is possible to have osteopenia (low bone mass) or osteoporosis at a much earlier age. As osteoporosis has no obvious symptoms, it’s important to go to your doctor if any risk factors apply to you.

By making positive lifestyle changes and following appropriate treatment strategies in consultation with a doctor, osteoporotic fractures can be prevented. Your doctor will take a thorough medical history that includes information on any recent fractures and may determine the next step is to have a bone mineral density (BMD) test.Osteoporosis Diagnosis Essay

What is a BMD test?
Traditional X-rays can’t measure bone density, but they can identify spine fractures. Bone mineral density (BMD) has to be measured by more specialised techniques. A number of different types of BMD tests are available, but the most commonly used is DXA (dual-energy X-ray absorptiometry)

DXA is a low radiation X-ray capable of detecting quite small percentages of bone loss. It is used to measure spine and hip bone density, and can also measure bone density of the whole skeleton. There are a number of different types of test options [1]:Osteoporosis Diagnosis Essay

DXA (peripheral DXA) measures bone mass at the forearm, finger and heel
SXA (single-energy X-ray absorptiometry) measures the heel or wrist
DPA (dual photon absorptiometry) measures the spine, hip or total body
SPA (single photon absorptiometry) measures the wrist
QCT (Quantitative Computed Tomography) measures the spine or hip
PQCT (peripheral QCT) measures the forearm
QUS (Quantitative Ultrasound) uses sound waves to measurethe heel or finger
A DXA scan, which is used to measure spine and hip bone density, is the most common technique for assessing the risk of osteoporosis.

What do my test results mean?
The World Health Organization has defined a number of threshold values (measurements) for osteoporosis. The reference measurement is derived from bone density measurements in a population of healthy young adults (called a T-score). Osteoporosis is diagnosed when a person’s BMD is equal to or more than 2.5 standard deviations below this reference measurement [2].

Osteopenia is diagnosed when the measurement is between 1 and 2.5 standard deviations below the young adult reference measurement.Osteoporosis Diagnosis Essay

Status Hip BMD
Normal T-score of -1 or above
Osteopenia T-score lower than -1 and greater than -2.5
Osteoporosis T-score of -2.5 or lower
Severe osteoporosis T-score of -2.5 or lower, and presence of at least one fragility fracture

If the results of your BMD test show osteopenia or osteoporosis, it does not automatically mean that you will have a fracture. There are lifestyle changes and a number of available therapies that your doctor might prescribe to slow down bone loss and help prevent fractures.

How else do they diagnose osteoporosis?
There are a number of other methods for diagnosing osteoporosis that have been used extensively in clinical trials and epidemiological studies. These include radiological assessments and Bone Turnover Markers (BTM). Read more information on these methods of diagnosis.Osteoporosis Diagnosis Essay

Osteoporosis is the most common bone disease in humans and affects both men and women. The clinical and public health implications of the disease are substantial because of the mortality, morbidity, and cost of medical care associated with osteoporotic fractures. Osteoporosis is diagnosed on the basis of a low-impact or fragility fracture or low bone mineral density, which was best assessed by central dual-energy x-ray absorptiometry. Both nonpharmacological therapy (calcium and vitamin D supplementation, weight-bearing exercise, and fall prevention) and pharmacological treatments (antiresorptive and anabolic agents) may be helpful in the prevention and treatment of osteoporosis. Therefore, clinicians need to be vigilant in instituting primary prevention measures for those at high risk for osteoporosis and in instituting treatment for patients diagnosed as having the disease either by screening or a history of fracture. This article provides an overview of the diagnosis, screening, prevention, and treatment of osteoporosis.
BMD (bone mineral density), DXA (dual-energy x-ray absorptiometry), FDA (Food and Drug Administration), ICSI (Institute for Clinical Systems Improvement), NOF (National Osteoporosis Foundation)Osteoporosis Diagnosis Essay
Osteoporosis is the most common bone disease in humans and affects both men and women, usually during or beyond the seventh decade of life. Among US women older than 50 years, 13% to18% meet current diagnostic criteria for osteoporosis, and an additional 37% to 50% meet criteria for osteopenia. For men of the same age, 3% to 6% meet criteria for osteoporosis, and 28% to 47% meet criteria for osteopenia.1 Osteoporosis has clinical and public health implications because of the mortality, morbidity, and cost of medical care associated with osteoporotic fractures. Elderly persons constitute the fastest-growing age group in the world, and the annual number of osteoporotic fractures is predicted to increase considerably with the continued aging of this population in future decades. In the United States, about 1.5 million fractures are attributed to osteoporosis each year. Of this total, approximately half are vertebral fractures and one fifth each are hip, wrist, and other fractures,2 Although therapy that can reduce the risk of osteoporotic fractures is available, osteoporosis often remains undiagnosed until a fracture occurs. In addition, patients with osteoporosis-related fractures often are not evaluated or treated for osteoporosis and sustain additional fractures. Therefore, clinicians need to be vigilant in instituting primary prevention measures for those at high risk for osteoporosis and in instituting treatment for patients diagnosed with the disease either by screening or a history of fracture. This article provides an overview of the diagnosis, screening, prevention, and treatment of osteoporosis.Osteoporosis Diagnosis Essay
DEFINITION
Osteoporosis is a chronic, progressive disease characterized by low bone mass, microarchitectural bone deterioration, and decreased bone strength that lead to increased bone fragility and a consequent increase in fracture risk.3 Osteoporosis may be classified as either primary or secondary. Primary osteoporosis is bone loss associated with the aging process in both women and men and with the loss of gonadal function in men. In primary osteoporosis, the rate of activation of skeletal bone remodeling units is normal, but the filling of bone resorption pits is incomplete. Secondary osteoporosis is bone loss caused by a variety of chronic medical conditions, medications, and nutritional deficiencies. In most types of secondary osteoporosis, the rate of activation of skeletal bone remodeling units is increased at least initially, such that an increased proportion of the skeleton is undergoing remodeling at any one time. Some common secondary causes of osteoporosis and disease processes associated with the disorder Osteoporosis Diagnosis Essay

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Before 1994, the diagnosis of osteoporosis required evidence of a fragility fracture. In 1994, the World Health Organization established operational definitions of osteoporosis and osteopenia in postmenopausal white women based on bone mineral density (BMD) (Table 2) to help researchers and clinicians classify degrees of bone loss. Expert opinion, based on literature review, suggests that the current World Health Organization definition of osteoporosis in postmenopausal white women can be applied to men as well.5 In current clinical practice, osteoporosis is diagnosed on the basis of either a health outcome (low-impact or fragility fracture) or an intermediate outcome (low BMD). A low-impact fracture is one that occurs after a fall from standing height or less; a fragility fracture occurs spontaneously or with no trauma (cough, sneeze, sudden movement).
TABLE 2World Health Organization Definitions of Osteopenia and Osteoporosis in White Women3*
Normal Hip BMD >1.0 SD below the young adult female reference mean† (T score above −1.0)
Osteopenia Hip BMD between 1.0 and 2.5 SDs below the young adult female reference mean† (T score between −1.0 and −2.5)
Osteoporosis Hip BMD ≥2.5 SDs below the young adult female reference mean† (T score at or below −2.5)
Severe osteoporosis or established osteoporosis Hip BMD ≥2.5 SDs below the young adult female reference mean† in the presence of 1 or more fragility fractures
* Based on hip bone mineral density (BMD) measurements assessed with dual-energy x-ray absorptiometry.
† The young adult female reference mean is determined with use of the mean hip BMD from the National Health and Nutrition Examination Survey reference database of women aged 20–29 years.Osteoporosis Diagnosis Essay
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Although multiple technologies are available for measurement of BMD, central dual-energy x-ray absorptiometry (DXA) of the hip (femoral neck or total hip) is the gold standard for diagnosing osteopenia or osteoporosis.5, 6 However, many experts, including the International Society for Clinical Densitometry, recommend using the lowest central DXA T score of posteroanterior lumbar spine, femoral neck, or total hip (or the 33% distal radius of the nondominant forearm, if measured) to make the diagnosis.7 Dual-energy x-ray absorptiometric measurements of BMD at other sites (including the trochanter, Ward triangle, lateral lumbar spine, other forearm regions, heel, or total body) or with other technologies (calcaneal ultrasonography, peripheral DXA, quantitative computed tomography, single- or dual-photon radionuclide absorptiometry, or magnetic resonance imaging) may be useful for assessingrisk of fracture, but they are not recommended for use in diagnosing osteoporosis.6, 7 If DXA measurements at different sites are considerably disparate, most clinicians would use the lowest BMD measurement.
Dual-energy x-ray absorptiometric measurement of bone density is noninvasive, accurate, reproducible, and predictive of short- and long-term fracture risk. The results are reported as a density measurement in gm/cm2, in addition to T and Z scores. T scores represent the number of SDs from the mean bone density values in normal sex-matched young adults. The T score is used to make a diagnosis of normal bone density, osteoporosis, or osteopenia in postmenopausal women and in men age 50 years and older. Z scores represent the number of SDs from the normal mean value for age- and sex-matched control subjects. A Z score of -1.0 or lower (many experts suggest using a Z score of -2.0 or lower) may suggest the presence of a secondary cause of osteoporosis, although no definitive data support this hypothesis. Z scores are used preferentially to assess bone loss in premenopausal females and in men younger than age 50 years. A Z score of -2.0 or lower is defined as “below the expected range for age”; a Z score above -2.0 is “within the expected range for age.”7
ROLE OF SCREENING
Osteoporosis is a disease in which screening of asymptomatic individuals may be beneficial because it has a long preclinical course before the onset of fracture and because of the availability of both a reliable test to establish the diagnosis and treatments that have been shown to reduce the risk of fractures. General consensus exists regarding the recommendation that osteoporosis screening with BMD measurements should be individualized, but how this individualized approach to screening should be achieved remains controversial.Osteoporosis Diagnosis Essay
Many national and organizational guidelines and systematic reviews have attempted to outline clinical criteria for screening individuals for osteoporosis. Disagreement among the published guidelines reflects, at least in part, variances in expert opinion and gaps in the available evidence to support these recommendations. Most guidelines recommend using risk factor assessment to help select patients for bone density testing, but because of inadequate data, no consensus exists about which risk factors are most important to consider. Several groups have suggested guidelines for BMD testing in postmenopausal women, the population group for which the most evidence is available.
In the United States, a commonly accepted guideline is that of the National Osteoporosis Foundation (NOF)8 (Table 3). However, use of this guideline may result in more frequent testing because the risk factors listed are so common in this population. The US Preventive Services Task Force has also made recommendations regarding osteoporosis screening in postmenopausal women9 (Table 4). These guidelines are conservative and formulated from evidence-based literature review. Unfortunately, they may not be useful clinically because they do not clearly address which postmenopausal women who are younger than 65 years should be tested and do not recommend screening any postmenopausal women younger than age 60 for any reason, even though women between menopause and age 60 experience rapid early postmenopausal bone loss. Osteoporosis Diagnosis Essay