Osteoporosis physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]
Overview
Osteoporosis is generally asymptomatic initially, until the loss of bone mass leads to a fracture. Fractures can be acute and chronic and may involve the femoral neck and vertebral bones. femoral fractures result in immobilization while vertebral fractures may present as Dowager's hump. Secondary causes of osteoporosis such as chronic corticosteroid use or hyperthyroidism may present with symptoms associated with the causative condition.
Physical examination
Physical examination of patients with osteoporosis is usually remarkable for bone pain in case of a fracture. Osteoporosis is generally asymptomatic initially, until the loss of bone mass results in a fracture. These fractures may be acute or chronic, mostly involving the femoral neck and vertebral bones. The main feature of femoral fracture is immobilization and the main feature of vertebral fracture is Dowager's hump appearance.
Appearance of the patient
- In case of acute fractures, patients may appear anxious and distressed because of pain. Risk factors predisposing to acute fractures include being elderly, thin, asian or caucasian female of short stature.
- Osteoporosis due to chronic corticosteroid use may present with features of cushing's syndrome such as Buffalo hump, abdominal striae, moon-like faces, and edematous eyelids.
- Patients may exhibit physical characteristics of other secondary causes of osteoporosis, such as hyperthyroidism (proptosis, tremor, and restlessness).
Vital Signs
All vital signs (i.e., blood pressure, pulse rate, respiratory rate, and temperature) are normal in osteoporosis.
Skin
- Normal
- Striae may be present if there is chronic corticosteroid use[1]
HEENT
- Normal
- Characteristic moon-like face if excessive corticosteroid use[1]
Neck
- Thyromegaly in case of hyperthyroidism[2]
Abdomen
- Hepatomegaly may be found due to hemochromatosis or alcoholism[3]
Back
- Point tenderness in case of fractures
- Stooped back, "Dowager's hump"[4]
- Kyphoscoliosis [4]
- Shortened spinal column
- Buffalo hump[1]
Genitourinary
Extremities
- Fracture or previously healed fractures may be present
- Peripheral muscle atrophy with chronic corticosteroid use[1]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Tomita A (1998). "[Glucocorticoid-induced osteoporosis--mechanisms and preventions]". Nippon Rinsho (in Japanese). 56 (6): 1574–8. PMID 9648484.
- ↑ Dhanwal DK (2011). "Thyroid disorders and bone mineral metabolism". Indian J Endocrinol Metab. 15 (Suppl 2): S107–12. doi:10.4103/2230-8210.83339. PMC 3169869. PMID 21966645.
- ↑ Linguraru MG, Sandberg JK, Jones EC, Petrick N, Summers RM (2012). "Assessing hepatomegaly: automated volumetric analysis of the liver". Acad Radiol. 19 (5): 588–98. doi:10.1016/j.acra.2012.01.015. PMC 3319283. PMID 22361033.
- ↑ 4.0 4.1 Weale R, Weale M (2012). "The Dowager's hump: an early start?". Gerontology. 58 (3): 212–5. doi:10.1159/000329828. PMID 21876336.
- ↑ Dupree K, Dobs A (2004). "Osteopenia and male hypogonadism". Rev Urol. 6 Suppl 6: S30–4. PMC 1472878. PMID 16985910.