1. -test for L1-L2= Cremasteric Reflex& Hip movement -test L5-S2= planter & dorsiflection of the foot -test S2-S4= Anal sphincter tone -Compression back vertebral fracture is the MOST COMMON S/S of osteoporosis. - Rx is a must w/ Vit. D & Ca supplements in all pregnancy age pt. & post menopausal pt. the addition of bisphosphonates depends on the presence of a fracture or a T-score more then 2.5
2. Rx. I. & II. use Bisphosphonate: I.(PO) Alandronate, Risedronate), II. (IV) Pamidronate; III.Parathyroid hormone PTH 1-34, teriparatide(SC)
3. fever + CNS S/S
   1. Dx. Epidural Spinal Abscess, MCC S Aureus
      1. Inv.Gadolinium Enhanced MRI is better then CT
         1. Rx. Prep for emergency surgery for Incision & Drainage + Antibiotics for 6-8weeks( Vancomycine(IV)+Metronidazole(IV)+Ceftriaxone(IV) + MRI every 4 weeks for follow up
4. Risk factors: postmenopausal, female, white, family hx. of osteoporosis or fragility fracture, osteopenic, steroid Rx, body weight less then 127 lb., or smoking
   1. Dx. Osteoporosis
      1. Inv. BASELINE central (=hip & lumbar spine)DEXA for Dx. and follow-up Rx effect
         1. T-score
            1. more than 1
            2. Normal
            3. between -1 to -2.5
            4. Dx. Osteopenic
            5. T-score of -1.5 with one or more risk factor
            6. T-score of -2.0 or less
            7. less than -2.5
            8. Dx. Osteoporosis
            9. Any T-score with any fragility fracture
5. old Male, bone pain at weight bearing sites,
   1. Dx. Paget's
      1. Inv. Xray: Cortex thickning, and osteosclerotic changes, Technetium scan shows increased uptake
         1. Rx. I. start Rx. only if there is S/S involvement of bone, nerves, Heart, or high Ca, or high ca in urine
6. elderly, Rapidly progressive unresponsive osteoporosis, weight loss
   1. Dx. Multiple Myeloma
      1. Inx. X-ray: osteopenia, may have punched out lesion
         1. Inv. Serum & Urine protein electrophoresis