What is the focus of the physical exam for organ transplantation-related osteoporosis?

Updated: Jul 02, 2020
  • Author: Carmel M Fratianni, MD, FACE; Chief Editor: George T Griffing, MD  more...
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Answer

Answer

Record height and weight, along with any loss of height or kyphosis, which could suggest occult compression fracture.

The examiner should be alert for the presence of blue sclerae, which suggest underlying osteogenesis imperfecta.

Any scoliosis or other regions of bony deformity should be noted. These deformities have the potential to render bone density determinations inaccurate in these regions, and the physician or technician performing bone densitometry should be made specifically aware of them.

Any areas of bone tenderness or pain, which could suggest occult fracture, avascular necrosis, or osteomalacia, should prompt further diagnostic evaluation.

Incapacitating pain or tenderness in the lower extremities or bones of the feet following organ transplantation could suggest the calcineurin-inhibitor–induced pain syndrome (CIPS), an unusual side effect of cyclosporine or tacrolimus.

CIPS may be accurately diagnosed by its typical presentation, negative inflammatory markers (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]), and characteristic magnetic resonance imaging finding with altered bone marrow signal. The reduction of cyclosporine or tacrolimus trough levels and the administration of calcium channel blockers has led to relief of pain, although in some cases bone marrow edema on follow-up MRI and pain syndrome resolved over 3 months without specific therapy. [67, 68]


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