Paper III — Bone and joint

Final Night Grid — One Line Per Topic

Topic The one sentence to write first

Osteoporosis Low bone mass with microarchitectural deterioration; T-score ≤−2.5, or any fragility fracture regardless of T-score. Post-hip-fracture Treat before discharge — imminent re-fracture risk is highest in the first 2 years; IV zoledronate plus a Fracture Liaison Service.

DEXA Reference standard for BMD; diagnose on the lowest valid site, monitor every 1–3 years, beware degenerative spine in the elderly.

FRAX 10-year probability of hip and major osteoporotic fracture from 11 clinical factors ± femoral neck BMD; blind to falls and fracture recency.

SERMs Bone agonist, breast antagonist; vertebral fracture protection only; contraindicated after femoral neck fracture. Atypical femur Transverse subtrochanteric/diaphyseal fracture with lateral cortical beaking after prolonged turnover suppression; fracture often bilateral.

Renal Bone histology of CKD classified by Turnover, Mineralisation and Volume; adynamic bone disease is now commonest. osteodystrophy Osteoarthritis Exercise and weight loss are the only disease-modifying measures; topical before oral NSAIDs; joint replacement for refractory severe disease.

Polymyalgia Girdle pain and stiffness over 50 with high ESR, normal CK, and dramatic response to prednisolone 15 mg. rheumatica Temporal arteritis Granulomatous large-vessel vasculitis — a sight-threatening emergency; steroids first, biopsy after. Late-onset RA Onset ≥60, equal sex ratio, abrupt, large proximal joints, often seronegative with very high ESR. Sjögren's syndrome Autoimmune epithelitis causing sicca; exclude anticholinergic drugs first; lifelong lymphoma vigilance. Inflammatory DM (complement microangiopathy), PM (CD8 cytotoxicity), IBM (rimmed vacuoles, steroid-unresponsive, commonest myopathies over 50).

Psoriatic arthropathy Enthesitis-driven seronegative spondyloarthritis with dactylitis, nail disease and pencil-in-cup erosions. Compiled from Pathy's Principles and Practice of Geriatric Medicine (6th edition) and Kane's Essentials of Clinical Geriatrics, with clearly separated evidence updates from guidelines, regulatory approvals and randomised trials published 2023 to date.