Osteoporosis physical examination: Difference between revisions

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{{Osteoporosis}}
{{Osteoporosis}}
{{CMG}} {{AE}} {{RT}}
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==Overview==
==Overview==
[[Osteoporosis]] is associated with the presence of fractures on physical examination. Otherwise, there are no characteristic findings on physical examination.
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|vertebral bones]]. [[femoral]] [[fracture|fractures]] result in immobilization while [[vertebral]] [[fracture]]<nowiki/>s 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.


==Appearance of the Patient==
==Physical examination==
[[Osteoporosis]] is asymptomatic, until fractures occur due to poor bone mineralization. Such patients may appear anxious and distressed because of pain. Based on risk factors, the patient may likely be elderly, female, thin, of small stature, and asian or caucasian. If they have osteoporosis due to chronic [[steroid]] use, they may also exhibit the physical characteristics that appear due to chronic steroid use. They may exhibit physical characteristics of other secondary causes of osteoporosis, such as [[hyperthyroidism]].
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|vertebral bones]]. The main feature of [[femoral]] [[fracture]] is immobilization and the main feature of [[vertebral]] [[fracture]] is Dowager's hump appearance.


==Vital Signs==
=== Appearance of the patient ===
===Temperature===
* 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.
*Temperature is normal.
* [[Osteoporosis]] due to chronic [[steroid|corticosteroid]] use may present with features of cushing's syndrome such as [[Buffalo hump]], [[Striae|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]]).


===Pulse===
===Vital Signs===
====Rate====
All [[vital signs]] (i.e., [[blood pressure]], [[pulse rate]], [[respiratory rate]], and [[temperature]]) are normal in [[osteoporosis]].
*Normal
====Rhythm====
*Regular
====Strength====
*The pulse is normal
====Symmetry====
*The pulses are symmetric
===Blood Pressure===
*Normal
*[[Blood pressure]] may be elevated in chronic steroid use or hyperthyroidism, both of which are risk factors for osteoporosis
 
===Respiratory Rate===
*Normal


==Skin==
===Skin===
*Normal
*Normal
*Striae may be present if there is chronic [[corticosteroid]] use, and signifying a risk factor for osteoporosis
*[[Striae]] may be present if there is chronic [[corticosteroid]] use<ref name="pmid9648484">{{cite journal |vauthors=Tomita A |title=[Glucocorticoid-induced osteoporosis--mechanisms and preventions] |language=Japanese |journal=Nippon Rinsho |volume=56 |issue=6 |pages=1574–8 |year=1998 |pmid=9648484 |doi= |url=}}</ref>


==Head==
===HEENT===
* Normal
* Normal
* Characteristic round "puffy" face may be present with chronic steroid use, signifying a risk factor for osteoporosis
* Characteristic moon-like face if excessive corticosteroid use<ref name="pmid9648484" />
 
===Neck===
==Eyes==
*[[Thyromegaly]] in case of hyperthyroidism<ref name="pmid21966645">{{cite journal| author=Dhanwal DK| title=Thyroid disorders and bone mineral metabolism. | journal=Indian J Endocrinol Metab | year= 2011 | volume= 15 | issue= Suppl 2 | pages= S107-12 | pmid=21966645 | doi=10.4103/2230-8210.83339 | pmc=3169869 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21966645  }}</ref>
*Normal. No [[icterus]].
 
==Ears==
*Normal
==Nose==
*Normal
==Throat==
*Normal
==Neck==
*[[Jugular venous pressure]] not elevated
*[[Carotid bruits]] not present
*[[Lymph nodes]] not present
*[[Thyromegaly]] may be present in [[hyperthyroidism]]
*[[Hepatojugular reflux]] is absent
* Large fat pad at the back of neck may be present due to chronic steroid use, which is a risk factor for osteoporosis
 
==Heart==
*Normal


==Lungs==
===Abdomen===
*Normal. No added sounds
* [[Hepatomegaly]] may be found due to [[hemochromatosis]] or [[alcoholism]]<ref name="pmid22361033">{{cite journal| author=Linguraru MG, Sandberg JK, Jones EC, Petrick N, Summers RM| title=Assessing hepatomegaly: automated volumetric analysis of the liver. | journal=Acad Radiol | year= 2012 | volume= 19 | issue= 5 | pages= 588-98 | pmid=22361033 | doi=10.1016/j.acra.2012.01.015 | pmc=3319283 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22361033  }}</ref>


===Auscultation===
*Central [[obesity]]<ref name="pmid9648484" />
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]] present
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]] present


==Abdomen==
=== Back ===
*[[Abdominal distention]] absent
* Point [[tenderness]] in case of [[fractures]]
*[[Abdominal tenderness]] absent
* Stooped back, "Dowager's hump"<ref name="pmid218763362">{{cite journal |vauthors=Weale R, Weale M |title=The Dowager's hump: an early start? |journal=Gerontology |volume=58 |issue=3 |pages=212–5 |year=2012 |pmid=21876336 |doi=10.1159/000329828 |url=}}</ref>
*[[Rebound]] absent
* [[Kyphoscoliosis]] <ref name="pmid218763362" />
*[[Hepatomegaly]] usually absent, liver may be palpable in liver disease due to [[hemochromatosis]] or [[alcoholism]], both of which are risk factors for osteoporosis.
* Shortened [[spinal column]]
*[[Splenomegaly]] absent
* [[Buffalo hump]]<ref name="pmid9648484" />
* Central [[obesity]] and striae may be seen in chronic steroid use, a risk factor for osteoporosis
* [[Hypogonadism]] may be evident on genitourinary exam, and is a risk factor for osteoporosis


==Extremities==
=== Genitourinary ===
*[[Clubbing]] absent
* [[Hypogonadism]]<ref name="pmid16985910">{{cite journal| author=Dupree K, Dobs A| title=Osteopenia and male hypogonadism. | journal=Rev Urol | year= 2004 | volume= 6 Suppl 6 | issue=  | pages= S30-4 | pmid=16985910 | doi= | pmc=1472878 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16985910  }}</ref>
*[[Cyanosis]] absent
*[[Edema]] absent
*[[Fracture]] or previously healed fractures may be present
*Peripheral muscle atrophy may be present with chronic steroid use, a risk factor for osteoporosis
*The patient may have experienced a decrease in height due to [[vertebral compression fractures]].


==Neurologic==
===Extremities===
*Normal examination
*[[Fracture]] or previously healed [[fractures]] may be present
*Peripheral [[Muscle-plate|muscle]] [[atrophy]] with chronic [[corticosteroid]] use<ref name="pmid9648484" />


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WS}}
{{WH}}


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[[Category:Medicine]]
[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Radiology]]
[[Category:Up-To-Date]]
[[Category:Orthopedics]]
[[Category:Primary care]]

Latest revision as of 23:28, 29 July 2020

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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

Vital Signs

All vital signs (i.e., blood pressure, pulse rate, respiratory rate, and temperature) are normal in osteoporosis.

Skin

HEENT

  • Normal
  • Characteristic moon-like face if excessive corticosteroid use[1]

Neck

Abdomen

Back

Genitourinary

Extremities

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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. ↑ 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.
  5. ↑ Dupree K, Dobs A (2004). "Osteopenia and male hypogonadism". Rev Urol. 6 Suppl 6: S30–4. PMC 1472878. PMID 16985910.

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