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{{Osteoporosis}}
{{Osteoporosis}}
{{CMG}} {{AE}}{{RT}}
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==Overview==
==Overview==
[[Osteoporosis]] is generally [[asymptomatic]] during initial years; until the [[bone mass]] loss rich to the point that [[fractures]] occur. These [[fractures]] could be divided to acute and chronic ones; mostly involve [[femoral neck]] and [[Vertebral|vertebral bones]], respectively. The main feature of [[femoral]] [[fracture]] is immobilization and the main feature of [[vertebral]] [[fracture]] is Dowager's hump appearance. Any other secondary causes of the disease (e.g., chronic [[corticosteroid]] use or [[hyperthyroidism]]) may have their own symptoms; signifying a risk factor for [[osteoporosis]].
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.


==Physical examination==
==Physical examination==
[[Osteoporosis]] is generally [[asymptomatic]] during initial years; until the [[bone mass]] loss rich to the point that [[fractures]] occur. These [[fractures]] could be divided to acute and chronic ones; mostly involve [[femoral neck]] and [[Vertebral|vertebral bones]], respectively. The main feature of [[femoral]] [[fracture]] is immobilization and the main feature of [[vertebral]] [[fracture]] is Dowager's hump appearance.  
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.


=== Appearance ===
=== Appearance of the patient ===
* In case of acute [[fractures]], patients may appear [[anxious]] and distressed because of pain. Based on risk factors, the patient may likely be elderly, female, thin, of short stature, and Asian or Caucasian.  
* 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.
* If they have [[osteoporosis]] due to chronic [[steroid|corticosteroid]] use, they may also exhibit the physical characteristics of chronic [[corticosteroid]] use; such as [[Buffalo hump]], [[Striae|abdominal striae]], moon-like faces, and edematous [[eyelids]].  
* [[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]].  
* They may exhibit physical characteristics of other secondary causes of [[osteoporosis]], such as [[hyperthyroidism]] (include [[proptosis]], [[tremor]], and [[restlessness]]).
* Patients may exhibit physical characteristics of other secondary causes of [[osteoporosis]], such as [[hyperthyroidism]] ([[proptosis]], [[tremor]], and [[restlessness]]).


===Vital Signs===
===Vital Signs===
====Temperature====
All [[vital signs]] (i.e., [[blood pressure]], [[pulse rate]], [[respiratory rate]], and [[temperature]]) are normal in [[osteoporosis]].
*Normal without fever


==== Blood pressure ====
* Normal
====Pulse rate====
* Normal rate, [[rhythm]], and strength
====Respiratory rate====
*Normal
===Skin===
===Skin===
*Normal
*Normal
*[[Striae]] may be present, if there is chronic [[corticosteroid]] use; 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 moon-like face (i.e., round "puffy" face) may be present with chronic [[corticosteroid]] use; signifying a risk factor for [[osteoporosis]]
* Characteristic moon-like face if excessive corticosteroid use<ref name="pmid9648484" />
===Neck===
===Neck===
*[[Thyromegaly]] may be present in [[hyperthyroidism]]
*[[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>


===Abdomen===
===Abdomen===
*[[Hepatomegaly]] usually absent
* [[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>
**[[Hepatomegaly]] may be found due to [[hemochromatosis]] or [[alcoholism]]; both signifying risk factors for [[osteoporosis]]
 
*Central [[obesity]] and [[striae]] may be seen in chronic [[corticosteroid]] use; signifying a risk factor for [[osteoporosis]]
*Central [[obesity]]<ref name="pmid9648484" />


=== Back ===
=== Back ===
* Point [[tenderness]] may be seen in case of [[fractures]]
* Point [[tenderness]] in case of [[fractures]]
* Stooped back, "Dowager's hump"; caused by compression of [[vertebrae]]
* 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>
* [[Kyphoscoliosis]] may be seen
* [[Kyphoscoliosis]] <ref name="pmid218763362" />
* Shortened [[spinal column]]; caused by compression of [[vertebrae]]
* Shortened [[spinal column]]
* [[Buffalo hump]] (Large fat pad at the back of neck) may be present due to chronic [[corticosteroid]] use; signifying a risk factor for [[osteoporosis]]
* [[Buffalo hump]]<ref name="pmid9648484" />


=== Genitourinary ===
=== Genitourinary ===
* [[Hypogonadism]] may be evident; signifying a risk factor for [[osteoporosis]]
* [[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>


===Extremities===
===Extremities===
*[[Fracture]] or previously healed [[fractures]] may be present
*[[Fracture]] or previously healed [[fractures]] may be present
*Peripheral [[Muscle-plate|muscle]] [[atrophy]] may be present with chronic [[corticosteroid]] use; signifying a risk factor for [[osteoporosis]]
*Peripheral [[Muscle-plate|muscle]] [[atrophy]] with chronic [[corticosteroid]] use<ref name="pmid9648484" />


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


​​
[[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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