Internal Medicine

0521779407-16 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

1108 Osteonecrosis Osteoporosis

follow-up

■Minimize risk factors

■Monitor for signs and symptoms of osteonecrosis at other sites

complications and prognosis

■Secondary osteoarthritis in joints next to affected bone

■Progression to joint destruction inevitable without surgery

■Progression to total hip replacement may occur in many with core

decompression+/−grafting, but progression may be delayed by

years

OSTEOPOROSIS

ROBERT MARCUS, MD

history & physical

History

■Family history of osteoporosis

■Caucasian

■Amenorrhea

■Hypogonadism

■Avoidance of dietary calcium

■Lack of habitual weight-bearing exercise

■Bone toxic exposures: glucocorticosteroids, antiseizure medication,

systemic illness

■Smoking

■Alcoholism

■Thyrotoxicosis

■Celiac disease and other forms of intestinal malabsorption

Signs & Symptoms

■Asymptomatic until fractures

■Only 1/3 of vertebral fractures symptomatic

■Height loss can be early clue

■Deformity (kyphosis)

■Low-trauma fractures of spine and throughout the skeleton are the

essential clinical consequences of osteoporosis.

tests

Laboratory

■Basic blood studies: