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CONDITION/DISORDER SYNONYM

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  • Brittle Bones

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ICD-9-CM CODES

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  • 733.0 Osteoporosis

  • 733.00 Osteoporosis unspecified

  • 733.01 Senile osteoporosis

  • 733.02 Idiopathic osteoporosis

  • 733.03 Disuse osteoporosis

  • 733.09 Other osteoporosis

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ICD-10-CM CODES

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  • M81.0 Age-related osteoporosis without current pathologic fracture

  • M81.8 Other osteoporosis without current pathologic fracture

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PREFERRED PRACTICE PATTERNS

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  • 4A: Primary Prevention/Risk Reduction for Skeletal Demineralization

  • 4B: Impaired Posture

  • 4C: Impaired Muscle Performance

  • 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, ROM and Reflex Integrity Association with Spinal Disorders

  • 4G: Impaired Joint Mobility, Muscle Performance, and ROM Associated with Fracture

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PATIENT PRESENTATION

The patient is a 72-year-old woman who is having mid-thoracic pain after a coughing bout. The patient is having a dull ache pain that is constant. Upon X-rays, thoracic compression fractures are found. The patient received kyphoplasty surgery. Physical therapy treatment followed by progressive weight-bearing exercises.

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KEY FEATURES

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  • Deterioration of bone mass and density with a marked decrease in cortical thickness and cancellous bone trabeculae, which leads to increased fragility, deformity, and/or fracture.

  • Osteoporosis is initially categorized by etiology and skeletal localization then further divided into primary and secondary classifications.

  • Considered both a progressive and chronic disease with primary prevention tied to childhood bone health and reduced risk factors (skeletal and nonskeletal).

  • Primary osteoporosis

    • Type 1: Postmenopausal osteoporosis

    • Type 2: Age-associated (senile) osteoporosis

    • Idiopathic osteoporosis (juvenile, premenopausal women, middle-aged men)

  • Secondary osteoporosis (identifiable cause of bone loss)

    • Underlying disease, deficiency, or drug induced

  • The operational definition of osteoporosis by the World Health Organization (WHO) is bone density that falls 2.5 standard deviations (SDs) or more below the mean for a young healthy same sex adult; referred to as a T-score of -2.5.

  • Bone mineral density (BMD) measurements are related to both peak bone mass and bone loss.

  • Bone densitometry: Normal BMD within 1 SD of the mean; T-score at -1.0 and greater.

  • Bone densitometry: Low BMD (referred to as osteopenia) occurs between 1 and 2.5 SDs below the mean; T-score between -1.0 and -2.5.

  • Increased fracture propensity due to demineralization secondary to osteoporosis; often occurs at the spine, hips, pelvis, or wrist.

  • As a comorbid condition, low levels of serum 25-hydroxyvitamin D are noted.

  • Accurate patient and family medical histories and early recognition through physical examination may lead to improved therapeutic outcomes.

  • 10-year risk for fracture can be measured through Fracture Risk Assessments (FRAX® score).

  • Pharmacotherapy can be measured through changes in laboratory values.

  • Osteoporosis is considered a major public health problem of the elderly, especially postmenopausal women.

  • Lifetime osteoporosis-related fracture will be experienced by 50% of all women and 25% of all men over age 50.14

  • Persons with low BMD are at an increased risk for the development of osteoporosis; prevention is critical to reduce incidence.

  • According to the National Osteoporosis Foundation (NOF), over 10 million Americans have osteoporosis ...

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