HO Teaching 7/5/20

1. Xray lateral view of thoracolumbar spine showing vertebral compression fractures due to
osteoporosis.

History:
-Suggestive: post-menopausal age, female, chronic history of back pain, no other medical
illnesses
-SOCRATES (pain) , Ask for any recent trauma, history of low energy trauma fracture before,
family history of similar condition in first degree relatives, any loss of height, any
numbness/weakness
-Risk factors: low BMI, lifestyle, low vit D/calcium intake food, cigarette/alcohol intake,
medications, age of menopausal, occupation
-Rule out secondary causes of osteoporosis – regular medications taken, symptoms of
hyperthyroidism, LOW/LOA

O/E:
-posture, any kyphosis, gait
-any spinal tenderness/deformity
-any signs of secondary causes of osteoporosis

IX:
-to rule our secondary causes of osteoporosis – fbc, busecreat, liver function test, serum ca,
phosphate, albumin, parathyroid hormone, thyroid function test, DEXA scan

Management:
Non pharmacological:
-Ca & Vit D supplements, regular physical activity, prevention of fall (regular eye check & CVS
examination, eliminate medications tht cause dizziness, address any gait imbalance,
cognitive impairment), stop smoking/drinking

Pharmacological:
-SERMS (raloxifene 60mg OD)
-Biphosphonate (alendronate 70mg /week)
-Hormone replacement therapy
2. Due to chronic history of back pain – likely malignancy caused

History:

- SOCRATES (pain) , history of trauma, any numbness/weakness over bilateral upper/lower

limbs, any urinary/bowel incontinence
-any fever/night sweats, chronic cough/PTB contact
-systemic review
-LOA/LOW/family history of malignancy
-Social history (smoking, alcohol intake, regular medications taken, occupation)

O/E:
-general appearance, posture, gait
-spinal tenderness/deformity
-Lymph node examination, Thyroid examination, Lungs, abdominal examination, CVS, PR &
prostate examination
-Assess tone, power, sensation, reflex over bilateral Ul & LL
-Anal tone, perianal sensation
-Babinski

IX:
-FBC,busecreat, LFT, Ca, Mg, Po4, alb
-CXR
-CT spine / MRI spine
-CT-TAP (if suggestive of malignancy)

Mx:
-Analgesics: Opiods (like IV Tramadol 50mg TDS/Aqueous morphine or PCA morphine if pain
severe), T.PCM 1g QID, T. Gabapentin 300mg ON
-Refer necessary team involved if primary cause of malignancy is found, to get biopsy / HPE
-Refer spine team for further operation management
-Refer PT/OT, Rehab team
-Refer RTU team if suggestive of malignancy

3. A – Osteoporosis
Non pharmacological:
-Ca & Vit D supplements, regular physical activity, prevention of fall (regular eye check & CVS
examination, eliminate medications tht cause dizziness, address any gait imbalance,
cognitive impairment), stop smoking/alcohol
Pharmacological:
-SERMS (raloxifene 60mg OD)
-Biphosphonate (alendronate 70mg /week)
-Hormone replacement therapy
B – Osteopenia
Non pharmacological : Ca & Vit D supplements, regular physical activity, fall prevention, stop
smoking or alcohol
-If no multiple risk factors for osteoporosis present, then reassess BMD after 2 yrs
-If multiple risk factors present – can start pharmacological treatments
-SERMS (raloxifene 60mg OD)
-Biphosphonate (alendronate 70mg /week)