Osteoporosis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]

Overview

Osteoporosis is associated with the presence of fractures on physical examination. Otherwise, there are no characteristic findings on physical examination.

Appearance of the Patient

Osteoporosis is asymptomatic, until fractures occur due to poor bone mineralization. Such patients may appear anxious and distressed because of pain. Based on risk factors, the patient may likely be elderly, female, thin, of small stature, and asian or caucasian. If they have osteoporosis due to chronic steroid use, they may also exhibit the physical characteristics that appear due to chronic steroid use. They may exhibit physical characteristics of other secondary causes of osteoporosis, such as hyperthyroidism.

Vital Signs

Temperature

• Temperature is normal.

Pulse

Rate

• Normal

Rhythm

• Regular

Strength

• The pulse is normal

Symmetry

• The pulses are symmetric

Blood Pressure

• Normal
• Blood pressure may be elevated in chronic steroid use or hyperthyroidism, both of which are risk factors for osteoporosis

Respiratory Rate

• Normal

Skin

• Normal
• Striae may be present if there is chronic corticosteroid use, and signifying a risk factor for osteoporosis

Head

• Normal
• Characteristic round "puffy" face may be present with chronic steroid use, signifying a risk factor for osteoporosis

Eyes

• Normal. No icterus.

Ears

• Normal

Nose

• Normal

Throat

• Normal

Neck

• Jugular venous pressure not elevated
• Carotid bruits not present
• Lymph nodes not present
• Thyromegaly may be present in hyperthyroidism
• Hepatojugular reflux is absent
• Large fat pad at the back of neck may be present due to chronic steroid use, which is a risk factor for osteoporosis

Heart

• Normal

Lungs

• Normal. No added sounds

Auscultation

• S1 present
• S2 present

Abdomen

• Abdominal distention absent
• Abdominal tenderness absent
• Rebound absent
• Hepatomegaly usually absent, liver may be palpable in liver disease due to hemochromatosis or alcoholism, both of which are risk factors for osteoporosis.
• Splenomegaly absent
• Central obesity and striae may be seen in chronic steroid use, a risk factor for osteoporosis
• Hypogonadism may be evident on genitourinary exam, and is a risk factor for osteoporosis

Extremities

• Clubbing absent
• Cyanosis absent
• Edema absent
• Fracture or previously healed fractures may be present
• Peripheral muscle atrophy may be present with chronic steroid use, a risk factor for osteoporosis
• The patient may have experienced a decrease in height due to vertebral compression fractures.

Neurologic

• Normal examination