FRCS Case Studies

Osteoporosis

Candidate:

Candidate: A bone-density scan.

Candidate:

Candidate: A bone-density scan, also known as Dual-Energy X-ray Absorptiometry or DEXA scan, is a specialized type of X-ray that measures the amount of calcium and other bone minerals present in a segment of bone. This scan is primarily used for diagnosing and tracking osteoporosis, a medical condition characterized by a decrease in bone density leading to increased fragility and susceptibility to fractures.

Candidate:

Osteoporosis is a condition characterized by a decrease in the density of bone, reducing its strength and leading to fragile bones. The World Health Organization defines osteoporosis in women as bone mineral density 2.5 standard deviations below the peak bone mass of a healthy 20-year-old female, as measured on a DEXA scan. The primary risk factors for osteoporosis include low-impact fracture, new thoracic kyphosis, early menopause, a family history of hip or vertebral fracture in a first-degree relative under 65 years old, predisposing pathology such as hypothyroidism, rheumatoid arthritis, alcohol abuse, Cushing’s syndrome, malignancy, prolonged amenorrhea in the absence of pregnancy, and prolonged use of certain drugs like steroids, thyroxine, heparin, phenytoin, and chemotherapy.

Candidate:

The DEXA scan provides four key numerical results. First, it gives the percentage of normal bone density for the patient’s age, which can be useful in explaining the condition to patients. Second, it provides the Z-score, showing the standard deviation from normal for the patient’s age group. Third, it indicates the percentage of bone density compared with normal young adults, with ninety percent and above being considered normal. Fourth, it provides the T-score, which is the number of standard deviations from normal young adults, and this is the key number from which the World Health Organization derives its definition of osteoporosis. The T-score predicts fracture risk, with every -1 SD doubling the fracture risk. Osteoporosis is defined as a T-score > 2.5 SD below mean.

Candidate:

The treatment for osteoporosis as recommended by the National Institute of Health and Clinical Excellence involves lifestyle changes and pharmacological treatments. Lifestyle changes include weight-bearing exercises, reducing alcohol consumption, smoking cessation, and reducing fall risks. All patients should also take calcium and vitamin D supplements. Pharmacological measures include bisphosphonates as first-line treatment, which inhibit osteoclast function and hence bone resorption. Strontium ranelate is a second-line treatment that stimulates proliferation of the osteoblasts and inhibits the proliferation of osteoclasts. Raloxifene is a third-line treatment and is a selective oestrogen receptor modulator that stimulates new bone production. It’s also crucial to provide high-quality fracture care, ensure secondary prevention of fragility fractures, and provide high-quality information to patients.

FRCS Case Studies

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Osteoporosis

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