1. Chapter 48 Evaluation of Postmenopausal Osteoporosis © American Society for Bone and Mineral Research Contributed by Susan Greenspan and Marjorie Luckey

2. Who Should Have a Bone Mass Measured National Osteoporosis Foundation 2003 –All women age 65 and older –Postmenopausal women under age 65 with a risk factor –Postmenopausal women who present with fractures US Preventive Services Task Force 2002 –Postmenopausal women age 65 and older –Postmenopausal women age 60-64 with a risk factor © American Society for Bone and Mineral Research Contributed by Susan Greenspan and Marjorie Luckey

3. Classification of Osteoporosis using Central DXA World Health Organization ClassifcationT-score (SD units) Normal> -1 Low Bone Mass (osteopenia) -2.5 Osteoporosis< -2.5 © American Society for Bone and Mineral Research Contributed by Susan Greenspan and Marjorie Luckey

4. Most Common Secondary Causes of Low Bone Mass Endocrine Disorders –Hypogonadism –Hyperthyroidism –Hyperparathyroidism –Vitamin D insufficiency/deficiency Gastrointestinal disorders –Malabsorption (celiac disease, IBD) –Cirrhosis Bone marrow disorders –Leukemia and lymphoma –Multiple myeloma © American Society for Bone and Mineral Research Contributed by Susan Greenspan and Marjorie Luckey

5. Most Common Secondary Causes of Low Bone Mass (continued) Connective tissue disorders –Rheumatoid arthritis Renal disorders –Hypercalciuria Medications associated with low bone mass –Antiepileptics –Aromatase inhibitors –Chemotherapy/immunosuppressive agents –Corticosteroids –Excess thyroid hormone –Gonadotropin-releasing hormone agonists –Heparin © American Society for Bone and Mineral Research Contributed by Susan Greenspan and Marjorie Luckey

6. Work-up for Secondary Causes of Bone Loss CBC Chemistry profile including calcium 24-hour urinary calcium 25-hydroxyvitamin D TSH for women on thyroid hormone PTH if calcium is abnormal SPEP if CBC is abnormal Z-score <-2.0 prompts a thorough evaluation © American Society for Bone and Mineral Research Contributed by Susan Greenspan and Marjorie Luckey