Chapter 48 Evaluation of Postmenopausal Osteoporosis American Society
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Chapter 48 Evaluation of Postmenopausal Osteoporosis © American Society for Bone and Mineral Research Contributed by Susan Greenspan and Marjorie Luckey
Who Should Have a Bone Mass Measured • National Osteoporosis Foundation 2003 – All women age 65 and older – Postmenopausal women under age 65 with a risk factor – Postmenopausal women who present with fractures • US Preventive Services Task Force 2002 – Postmenopausal women age 65 and older – Postmenopausal women age 60 -64 with a risk factor © American Society for Bone and Mineral Research Contributed by Susan Greenspan and Marjorie Luckey
Classification of Osteoporosis using Central DXA World Health Organization Classifcation T-score (SD units) Normal > -1 Low Bone Mass (osteopenia) < -1 and > -2. 5 Osteoporosis < -2. 5 © American Society for Bone and Mineral Research Contributed by Susan Greenspan and Marjorie Luckey
Most Common Secondary Causes of Low Bone Mass • Endocrine Disorders – Hypogonadism – Hyperthyroidism – Hyperparathyroidism – Vitamin D insufficiency/deficiency • Gastrointestinal disorders – Malabsorption (celiac disease, IBD) – Cirrhosis • Bone marrow disorders – Leukemia and lymphoma – Multiple myeloma © American Society for Bone and Mineral Research Contributed by Susan Greenspan and Marjorie Luckey
Most Common Secondary Causes of Low Bone Mass (continued) • Connective tissue disorders – Rheumatoid arthritis • Renal disorders – Hypercalciuria • Medications associated with low bone mass – Antiepileptics – Aromatase inhibitors – Chemotherapy/immunosuppressive agents – Corticosteroids – Excess thyroid hormone – Gonadotropin-releasing hormone agonists – Heparin © American Society for Bone and Mineral Research Contributed by Susan Greenspan and Marjorie Luckey
Work-up for Secondary Causes of Bone Loss • • CBC Chemistry profile including calcium 24 -hour urinary calcium 25 -hydroxyvitamin D • • TSH for women on thyroid hormone PTH if calcium is abnormal SPEP if CBC is abnormal Z-score <-2. 0 prompts a thorough evaluation © American Society for Bone and Mineral Research Contributed by Susan Greenspan and Marjorie Luckey
