What are the complications of osteopenia?

Question

Hello doctor,

I am a 52-year-old woman diagnosed with osteopenia based on a DEXA scan. I have had two blood tests for multiple myeloma, and both were negative. However, I am repeatedly breaking ribs. No other bones are affected, but this past week, I broke yet another rib (my fifth in two years) while lifting my very fat cat in her carrier to take her to the vet.

I went to urgent care, where they performed an X-ray and an ultrasound (they suspected gallbladder issues due to the pain). The ultrasound technician pressed extremely hard, causing significant pain, even though I informed her that I believed my rib was broken. The X-ray confirmed a fracture in my seventh right rib, which was not displaced. I was told the ultrasound was normal, but when I reviewed the report, it stated: "Liver: Normal size and contours. Normal echogenicity and echotexture. Minimal perihepatic ascites."

Are ascites serious? I had not fasted beforehand, as I was not expecting an ultrasound, but I am unsure if that might explain the findings. The phrase "minimal perihepatic ascites" concerned me, though I assume the doctor would have mentioned it if it were serious. As the week progressed, I felt worse and went to my GP. She repeated the X-ray, which now shows three broken ribs. The previously fractured rib, which was initially not displaced, is now displaced. I strongly believe the ultrasound technician caused the other two fractures and displaced the third during the exam.

Please answer my questions:

Are "minimal perihepatic ascites" something I should be concerned about?
Are there any diseases, other than osteoporosis, that could explain my repeated rib fractures?
Why are my ribs breaking so easily while other bones show only minimal osteopenia per the DEXA scan?

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

What was your T-score on the DEXA (dual-energy X-ray absorptiometry) scan? Having multiple rib fractures with minimal trauma suggests that a bone biopsy might be necessary if the DEXA scan shows only osteopenia. Additionally, what are your vitamin D, serum calcium, phosphorus, and alkaline phosphatase levels? It would also be helpful to have your GP (general practitioner) arrange tests for NTx (N-terminal telopeptide) and CTx (C-terminal telopeptide), which are markers of bone loss, to better understand why your bones are so weak.

Finally, mild fluid around the liver may have been labeled as ascites. This could be related to the rib fracture. What are your liver function test results like? Your GP is in a better position to interpret this and determine the next steps. If you are particularly anxious about the finding, you might consider requesting a repeat ultrasound or an MRI (magnetic resonance imaging) to see if the fluid collection is receding.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

You are understandably concerned, as the answers you are seeking have not been provided by the investigations done so far. A CT (computed tomography) scan is not the ideal test for assessing bone health. The typical diagnostic protocol involves a technetium bone scan to identify areas of concern, followed by an MRI for detailed imaging, and finally, a bone biopsy to establish a definitive diagnosis.

The use of the term ascites is understandably worrisome, especially for someone with a family history of cancer and ascites. However, a CT scan of the abdomen is a highly sensitive investigation for ruling out liver cancer. In that regard, you can take some reassurance that your tests have been normal, which means most serious conditions have likely been ruled out.

To get to the root cause of your bone issues, a bone biopsy is essential. That is where your answers likely lie.

Regards.

Answer 3

Hello,

Welcome back to icliniq.com.

I am confident that your liver is normal and that the fluid is just a result of local trauma from the rib fracture. The word ascites might not be the best choice here because, if it were serious, your doctor would have investigated it further. To be thorough, consider getting a repeat ultrasound (hopefully with a gentler technician) or an MRI. I am sure the fluid will have decreased by now.

I hope this helps you.

Thank you.