MSK-23 · Osteoporosis Part 1

Osteoporosis Part 1. Topics: Diagnosis, DEXA, Risk Factors. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: That makes the total hip the best measurement for tracking subtle changes in bone density over time. Use the femoral neck to predict the danger. Use the total hip to track the progress. — Correct: There is no single preferred site for serial monitoring. The PA lumbar spine and the hip are both endorsed, each judged against its own site-specific least significant change (and the mean bilateral total hip when both hips are scanned). The total hip is genuinely more reproducible than the femoral neck, and the femoral neck alone is the site that is not favored for monitoring, because it carries the largest precision error of the three. (2) In the audio: Those margins are typically 3 to 5% at the spine and 4 to 6% at the hip. — Correct: The published least significant change values run about 5.3% at the lumbar spine, about 5.0% at the total hip and about 6.9% at the femoral neck. Teach roughly 5% at spine and total hip and up to about 7% at the femoral neck alone; grouping the hip with the femoral neck hides that the total hip is the more precise of the two, and every facility must measure its own value. (3) In the audio: A prior vertebral fracture confers a five-fold increased risk of another vertebral fracture and a two- to three-fold increased risk of a hip fracture. — Correct: The two most-cited syntheses put the multipliers closer to about four-fold for a further vertebral fracture and about two-fold for hip fracture after any prior fragility fracture. A prior fragility fracture is still the single strongest predictor; only the numbers run high. (4) In the audio: In the first five to 10 years of menopause, women drop bone mass by two to 3% per year. — Correct: The accelerated postmenopausal phase runs about 3 to 5 percent a year for roughly 5 to 7 years, on top of an age-related baseline of about 0.25 to 1 percent a year in both sexes. (5) In the audio: Hypogonadism is the most common secondary cause in men. — Correct: Hypogonadism, glucocorticoid excess and alcohol excess are the three leading identifiable secondary causes of osteoporosis in men, and no source ranks a single most common cause with confidence; the ranking shifts with the population studied. What is well supported is that roughly half to four-fifths of men with osteoporosis have an identifiable secondary cause. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-23.