vaibhavbora
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A 71-year-old man presents to his primary care provider complaining of nonradiating lower back pain over the past several months. On review of symptoms, he mentions feeling shorter than previously. Physical exam reveals a slight abnormal curve of the spine. Radiographic studies show anterior vertebral wedging and vertebral end-plate irregularity.
What is the most likely underlying pathology of this process?
A. Decreased osteoblast activity, normal osteoclast activity
B. Increased osteoblast activity, decreased osteoclast activity
C. Intervertebral disc degeneration
D. Intervertebral disc space calcification
E. Decreased osteoblast activity, increased osteoclast activity
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| loto
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c
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| sigh
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E.
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| vaibhavbora
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A is the correct answer
| vaibhavbora
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This patient is suffering from a compression fracture secondary to osteoporosis. Decreased osteoblast activity with normal osteoclast activity (choice A) will result in an overall decrease in bone density. This process occurs in primary osteoporosis type 2 (“senile osteoporosis&rdquo , which occurs in patients over 60 of both genders.
Increased osteoblast activity with decreased osteoclast activity (choice B) will result in an overall increase in bone density. This process is not associated with vertebral compression fractures.
Intervertebral disc degeneration (choice C) leads to disc herniation. This condition can cause lower back pain secondary to nerve root compression, classically radiating to the upper legs (“sciatica&rdquo. This pathology is inconsistent with the observed radiographic studies.
Intervertebral disc space calcification (choice D) typically affects preadolescent children. It usually is found in the thoracic and lumbar spine, and the course is self-limited.
Decreased osteoblast activity with increased osteoclast activity (choice E) will result in an overall decrease in bone density and may lead to a vertebral compression fracture. This process occurs in primary osteoporosis type 1 (“postmenopausal osteoporosis&rdquo, which is six times more common in women. In this process, loss of estrogen is thought to increase cytokine levels promoting osteoclast activity.
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| SILVER
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good question
too bad the party is over! 
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| sigh
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just switch the gender and ...I got it right
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| vaibhavbora
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