GeriQBank · Topic
Osteoporosis, metabolic bone disease, arthritis and vasculitis.
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Principle: two X-ray beams of different energies are passed through the body; differential attenuation by bone and soft tissue allows calculation of bone mineral content and areal bone mineral density (g/cm²). It is the reference…
Osteoporosis is a systemic skeletal disease in which bone mass is reduced and the microarchitecture of bone tissue deteriorates, so that bone becomes fragile and fractures easily. The WHO densitometric definition uses the DXA T-score:…
Constitutional: advancing age, female sex, postmenopausal state, prior fragility fracture (doubles future risk), parental hip fracture, small frame, and Caucasian or Asian ethnicity. Nutritional: low dietary calcium (Indian intake…
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Osteoporosis is a skeletal disease of low bone mass and micro-architectural deterioration of bone tissue, causing bone fragility and increased fracture risk. Operational (WHO) definition: BMD T-score ≤ −2.5 at spine or hip. It is a…
Polymyalgia rheumatica (PMR) is a chronic inflammatory rheumatic disease of older adults characterised by pain and morning stiffness of the shoulder, neck and hip girdles with a markedly raised acute-phase response, and a dramatic…
Giant cell arteritis (GCA), or temporal arteritis, is a granulomatous large- and medium-vessel vasculitis affecting the extracranial branches of the carotid artery, the aorta and its major branches, occurring almost exclusively in…
Paget’s disease of bone (osteitis deformans) is a focal disorder of greatly accelerated and disorganised bone remodelling, affecting one bone (monostotic) or several (polyostotic) — but never the entire skeleton, which distinguishes it…
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Source note. Paget's disease is not covered adequately in the uploaded textbooks. Pathy's 6th ed. carries only a single index entry (p. 1026), and Kane's mentions it in three places only — the metabolic bone disease laboratory table,…
A hip fracture after low-energy trauma in a 68-year-old is by definition a fragility fracture and establishes a clinical diagnosis of osteoporosis irrespective of the DXA T-score. Hip fracture carries substantial excess mortality, loss…
FRAX is an algorithm that integrates the weight of clinical risk factors for fracture, with or without BMD, and computes the 10-year probability of hip fracture and of a major osteoporotic fracture (hip, clinical spine, proximal…
Definition: SERMs are non-steroidal agents that bind the oestrogen receptor and act as tissue-selective agonists or antagonists — agonist on bone and lipids, antagonist on breast, with variable effect on the endometrium. Selectivity…
Definition: an atypical femoral fracture (AFF) is a stress or insufficiency fracture of the subtrochanteric region or femoral shaft occurring with minimal or no trauma, associated with prolonged suppression of bone turnover —…
Renal osteodystrophy is the spectrum of bone histological abnormalities occurring in chronic kidney disease. It is the skeletal component of the broader syndrome CKD–Mineral and Bone Disorder (CKD–MBD), which also includes biochemical…
Osteoarthritis is the commonest joint disease of older adults and a leading cause of pain, immobility and disability. Management is symptom-directed and function-directed, since no agent has been shown to reverse structural damage.…
Late-onset rheumatoid arthritis (LORA), also called elderly-onset RA, is rheumatoid arthritis with first symptom onset at or after 60–65 years, as distinct from young-onset RA growing old — a distinction that must be made explicitly in…
Sjögren's syndrome (Sjögren's disease) is a chronic systemic autoimmune exocrinopathy characterised by lymphocytic infiltration and destruction of the exocrine glands — principally the lacrimal and salivary glands — producing the sicca…
The idiopathic inflammatory myopathies (IIM) are acquired, immune-mediated diseases of skeletal muscle producing symmetrical proximal muscle weakness with muscle inflammation, raised muscle enzymes and extramuscular involvement. Pathy's…
Psoriatic arthritis (PsA) is a chronic, seronegative inflammatory arthritis associated with psoriasis, belonging to the spondyloarthritis family, characterised by enthesitis, dactylitis, axial disease, nail disease and skin psoriasis.…
Vitamin deficiencies in the elderly Vitamins and minerals are micronutrients — required in minute quantities but essential for life, functioning as hormones, antioxidants, enzyme cofactors, and in one-carbon metabolism and DNA…
(Note: the internationally correct abbreviation is DXA, not DEXA — formalised in the ISCD 2023 Official Positions.) DXA (dual-energy X-ray absorptiometry) passes two X-ray beams of different photon energies through the region of…
Sclerostin is a glycoprotein encoded by the SOST gene and secreted almost exclusively by osteocytes — the mechanosensing cells buried within bone. It binds the LRP5/6 co-receptors and thereby blocks canonical Wnt/β-catenin signalling,…
Osteoarthritis is a whole-joint disease characterised by focal hyaline cartilage destruction with joint space loss, subchondral sclerosis and osteophyte formation, together with synovial hypertrophy, capsular and ligamentous change and…
Giant cell arteritis is a granulomatous large- and medium-vessel vasculitis affecting the aorta and its extracranial branches, with a predilection for the superficial temporal, ophthalmic, posterior ciliary and vertebral arteries. It is…
Dermatomyositis is an idiopathic inflammatory myopathy combining characteristic cutaneous features with symmetrical proximal muscle weakness. The mechanism is humoral and complement-mediated: deposition of the C5b-9 membrane attack…
DISH (Forestier–Rotés-Querol disease, originally “senile ankylosing hyperostosis”) is a systemic, non-inflammatory skeletal disorder characterised by ossification and calcification of spinal and extraspinal ligaments and entheses,…
A fragility (osteoporotic) fracture results from low-energy trauma — typically a fall from standing height or less. It is the product of two independent factors: the fall (impact) and bone made fragile by ageing (osteoporosis).…
Bone metastases are common in breast cancer (65–75%), prostate cancer (65–90%) and lung cancer (17–64%), and bone lesions occur in 70–95% of people with multiple myeloma. Skeletal complications include bone pain, pathological fracture,…
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Definition and distinction. Osteomalacia is defective mineralisation of newly formed osteoid in the mature skeleton, most often due to vitamin D deficiency; the childhood equivalent is rickets. Contrast with osteoporosis, in which…
two days following a binge of alcohol. Most probable diagnosis and management The diagnosis is acute gout — podagra of the first metatarsophalangeal joint. Gout is characterised by intra-articular monosodium urate crystals and generally…
Question 32 covers the acute attack. This answer is weighted towards the whole disease — the four phases, urate-lowering therapy, treat-to-target, and the special problems of gout in the older adult. Give acute management in a single…
Definition and nomenclature. Pseudogout is acute inflammatory arthritis caused by deposition of calcium pyrophosphate dihydrate (CPPD) crystals in articular cartilage and fibrocartilage. The current terminology is "acute CPP crystal…
Definition. An inflammatory condition of older adults — essentially never below age 50 — producing pain and morning stiffness of the shoulder and pelvic girdles with a systemic inflammatory response. It causes painful muscles with…
Definition and classification. Inflammation of blood-vessel walls causing ischaemia, necrosis and organ damage. The Chapel Hill Consensus classifies by vessel size: large-vessel (giant cell arteritis, Takayasu arteritis); medium-vessel…
Source note. Late-onset rheumatoid arthritis is not covered adequately in the uploaded textbooks. Kane's discusses arthritis in older adults generally and provides the osteoarthritis versus inflammatory arthritis comparison table (used…
Definition and classification. A seronegative inflammatory arthritis associated with psoriasis, belonging to the spondyloarthropathy family. Moll and Wright's five patterns: (i) asymmetric oligoarthritis, (ii) symmetric polyarthritis…
Definition and classification. A chronic autoimmune exocrinopathy in which lymphocytic infiltration of exocrine glands causes dry eyes and dry mouth. Primary Sjögren's occurs alone; secondary Sjögren's accompanies rheumatoid arthritis,…
Definition. A skeletal disorder of reduced bone mass with micro-architectural deterioration, leading to bone fragility and increased fracture risk. The WHO densitometric definition is a value 2.5 standard deviations or more below the…