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Chapter 48 Evaluation of Postmenopausal Osteoporosis © American Society for Bone and Mineral Research Contributed by Susan Greenspan and Marjorie Luckey
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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
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Classification of Osteoporosis using Central DXA World Health Organization ClassifcationT-score (SD units) Normal> -1 Low Bone Mass (osteopenia) -2.5 Osteoporosis< -2.5 © American Society for Bone and Mineral Research Contributed by Susan Greenspan and Marjorie Luckey
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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
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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
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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
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