Osteoporosis Quiz

 

OSTEOPOROSIS:

Osteoporosis is the most common metabolic bone disease in the United States. It is clinically silent until there is a fracture of the bone. It is due to the insufficient bone formation or excessive bone absorption or a combination of the two. It is a progressive loss of trabeculae and decreases the ability of the bone to withstand loading. There are two classifications.

Primary
Juvenile
Idiopathic
Type 1 or postmenopausal
Type 2 or senile which is associated with the elderly

Secondary
Genetic/congenital
hypogonadal states
endocrine disorders
deficiency states
inflammatory diseases
hematologic and neoplastic disorders
medications

Bone mineral density (BMD) is measured with a central DXA test

 T-score within 1 SD (+1 or -1) of young adult mean is normal
 T – score of -1 to -2.5 osteopenia
 T-score of -2.5 SD or more below the young adult indicates osteoporosis
 T-score of -2.5 SD or more below with fragility fractures indicates severe osteoporosis
 Z scores adjust for age, sex, ethnicity or race
 Z-scores of -2.0 or lower are below the expected range for age
 Z-scores above -2.0 are within the expected range for age.

• Risk factors that are associated with osteoporosis are genetics, female, family weight of less than 85% of the norm or 127 lbs. Other factors include early or surgical menopause , pregnancy at a young age, sedentary lifestyle, alcoholism, poor nutrient absorption (celiac), low body fat, low calcium intake, low vitamin D levels, prolonged bed rest and anorexia.

• Vitamin D

• Medication such as corticosteroids, thyroid hormone medication and diuretics can increase bone loss.

• Exercise early in life, resistance and high impact exercises and aerobic activity is beneficial in reducing bone loss.

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Differential Diagnosis of the Spine Book

Headache

HEADACHE: CLASSIFICATIONS FROM THE INTERNATIONAL CLASSIFICATION OF HEADACHE DISORDERS

PRIMARY:

• Migraine
• Tension-type headache
• Trigeminal autonomic cephalgias
• Other primary headache disorders
• Cluster headache

SECONDARY

• Headache attributed to trauma or injury to the head and or neck
• Headache attributed to cranial or cervical vascular disorder
• Headache attributed to non- vascular intracranial disorder
• Headache attributed to a substance or its withdrawal
• Headache attributed to infection
• Headache attributed to disorder of homeostasis
• Headache attributed to disorders of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure
• Headache attributed to psychiatric disorder
CRANIAL NEUROPATHIES OR OTHER FACIAL PAIN AND OTHER HEADACHES

For more on headaches, refer to my kindle “Differential Diagnosis of the Spine” on Amazon.com. Soon to be available in soft cover format.
51SVGauWRgL
Differential Diagnosis of the Spine Book

Clinical Prediction Rule for Spinal Stenosis Quiz

CLINICAL PREDICTION RULE FOR LUMBAR SPINAL STENOSIS

One clinical prediction rule for lumbar spinal stenosis has the following predictor variables.
• bilateral symptoms
• leg pain is greater than back pain
• pain is present during walking and standing
• pain is resolved with sitting
• age is greater than 48

Variables Sensitivity Specificity +LR -LR Post test
Probability
1 .96 .20 1.2 .19 44%
2 .68 .62 1.80 .51 55%
3 .29 .88 2.50 .80 63%
4 .06 .98 4.60 .95 76%
5 .01 1.0 ∞ .99 99%