OSTEOPOROSIS DIAGNOSIS

WHAT IS GOLD STANDARD?


Dual energy X-ray absorptiometry
(DXA) is the gold standard for diagnosis
of osteoporosis.

BUT DXA IS NOT ESSENTIAL TO START TREATMENT

.

WHAT ARE THE ANTI-OSTEOPOROTIC THERAPIES AVAILABLE

A Little Death In Dixie1.CALCIUM AND VITAMIN D SUPPLEMENTATION
2.BISPHOPHONATES-?ACTIVE UPPER GI DISORDERS ARE CONTRAINDICATIONS
3.HORMONE THERAPY-?RISK OF THROMBOEMBOLISM
4.PARATHYROID HORMONE
5.SELECTIVE OESTROGEN RECEPTOR MODULATORS(SERM)-RISH SIMILAR TO HORMONE THERAPY(BUT REDUCES BREAST CANCER)
6.STRONTIUM RANELATE.

OSTEOPOROSIS IMPORTANT POINTS

Osteoporosis is an A Little Death In Dixieasymptomatic process until afracture occurs.



■ Adults who have one fracture
are 2-4 times more likely to
have another.
■ Bone densitometry may not be
essential before starting
medical therapy if X-ray
investigation shows one or
more vertebral fractures typical
of osteoporosis.
■ Most elderly people in highand
low-level residency care
have vitamin D deficiency.

Renal calculi -Important points

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■ Abdominal examination is
most rewarding after ensuring
adequate analgesia.
■ Plain KUB has a sensitivity of
only 45-59% and a specificity
as low as 77% – it cannot be
used to rule in or rule out the
diagnosis of ureteric calculi.
■ Infection with obstruction
mandates urgent
decompression.
■ There is evidence of
permanent nephron loss within
72 hours of complete
obstruction.
■ The likelihood of spontaneous
stone passage is determined
by stone size and position.
■ Fifteen to twenty per cent of
all patients with ureteric
calculi will require intervention
using ESWL, ureteroscopy or
percutaneous nephrolithotomy.

Renal calculi -indictions for early intervention

1.Obstruction with evidence of infection-urgent decompression.
2.larger calculi -more than 6mm
3.Bilateral obstruction.
4.An obstructed solitary or transplanted kidney.
5.Renal impairment.(review the definition of renal impairment)
6.Ongoing unacceptable discomfort.