Osteоpоrоsis & Osteopeniа (Study Outline) For study only—this is not medicаl аdvice or a substitute for professional care. 1. Background Definition: Osteoporosis: Systemic skeletal disorder with low bone mass and microarchitectural deterioration, leading to fragility fractures. Osteopenia: Mild reduction in bone density (precursor to osteoporosis). Pathophysiology: Bone resorption > bone formation → loss of trabecular and cortical bone. Estrogen deficiency (postmenopause) and aging are key mechanisms. Leads to decreased bone strength without affecting mineralization. Diagnostic Criteria (DEXA T-scores): Category T-score Normal ≥ –1.0 Osteopenia –1.0 to –2.5 Osteoporosis ≤ –2.5 Severe (established) ≤ –2.5 + fragility fracture Epidemiology: Common in postmenopausal women and elderly men. Major cause of hip, vertebral, and wrist fractures in adults >50 years. Risk Factors: Non-modifiable: advanced age, female sex, white/Asian race, family history, early menopause. Modifiable: low BMI, smoking, alcohol, inactivity, low calcium/vitamin D intake. Secondary causes: glucocorticoids, hyperthyroidism, Cushing syndrome, hypogonadism, malabsorption, CKD, anticonvulsants. 2. History Often asymptomatic until fracture occurs. Typical Manifestations: Vertebral compression fractures → height loss, kyphosis (“dowager’s hump”), back pain. Hip or wrist fractures after minimal trauma. Chronic pain and functional decline. Historical Clues: Menopause, long-term steroid therapy, or secondary endocrine disease. 3. Exam Findings Spine: Kyphosis, height loss, tenderness over vertebrae. Gait: Unsteady, limited mobility post-fracture. Extremities: No deformity unless fracture present. Other systems: Usually normal labs and general appearance. 4. Making the Diagnosis Gold Standard: Dual-energy X-ray absorptiometry (DEXA) Measure at lumbar spine and hip; sometimes forearm if others unreliable. Typical Laboratory Findings (Primary Disease): Calcium, phosphate, ALP, PTH, vitamin D — all normal. Abnormal results suggest secondary osteoporosis (e.g., hyperparathyroidism, osteomalacia). Additional Evaluation: Screening: Women ≥65 years, or
Sectiоn One, Pаrt Twо - Grаmmаr (Questiоns 16 - 31) Select the one choice that makes the sentence correct. If the sentence is correct as is, select "No Change". Example: Pablo es___muchacho a. un b. una c. unas d. unos "a" is the right answer. Este es el disco ______ compré.
Pаssаge Five (Questiоns 50 - 53) Cuаndо el niñо estudiaba su carrera sucedió uno de esos cambios que tan comunes son en la edad juvenil. De perezoso se volvió trabajador. Cumplía bien sus deberes escolásticos. No sólo iba a clase puntualmente, sino que se ponía en la primera fila para mirar mejor al profesor. Al terminar la clase el niño era uno de los que interrumpían al profesor para pedirle que les explicara un punto oscuro de la lección. Se sentaba muy cerca del profesor.