A patient with hip joint pain is referred to physical therapy for direction in strengthening exercises performed in weight bearing positions. The physician’s referral notes that recent bone density testing revealed the patient has osteopenia. Which of the following comorbidities would MOST likely be part of the patient’s medical history?

1. Cushing’s syndrome
2. Guillain-Barre syndrome
3. Spinal stenosis
4. Complex regional pain syndrome

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders Team with the opportunity to explore challenging multiple choice examination questions with students actively preparing for the licensing examination.

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A patient with hip joint pain is referred to physical therapy for direction in strengthening exercises performed in weight bearing positions. The physician’s referral notes that recent bone density testing revealed the patient has osteopenia. Which of the following comorbidities would MOST likely be part of the patient’s medical history?

1. Cushing’s syndrome
2. Guillain-Barre syndrome
3. Spinal stenosis
4. Complex regional pain syndrome

Obviously, your ability to answer this question is going to depend primarily on your knowledge of osteopenia and the four pathologies.

Let’s start with osteopenia and progress to each of the options:

Osteopenia
Osteopenia is a condition presenting with low bone mass that is not severe enough to qualify as osteoporosis. Bone mineral density is used to diagnose osteoporosis and other low bone mass disorders. Individuals with osteopenia may not have actual bone loss, but a naturally lower bone density than established norms. A decrease in bone mass may be caused by prolonged drug therapies of heparin or corticosteroid use, endocrine disorders, malnutrition, and other disease processes.

Let’s explore each of the options.

Option 1 - Cushing’s syndrome
Cushing’s syndrome is a condition resulting from abnormally high levels of cortisol due to endogenous overproduction of cortisol or excessive exogenous use of corticosteroids. Symptoms evolve over years and can include persistent hyperglycemia, growth failure, truncal obesity, purple abdominal striae, “moon shaped face”, and weakness. Mental changes can include depression, poor concentration, and memory loss. High levels of cortisol in the body for a prolonged period changes the way in which bones are remodeled (i.e., decreased bone formation, increased bone resorption). These changes ultimately lead to osteopenia or osteoporosis for many of these patients. Bingo!

Option 2 - Guillain-Barre syndrome
Guillain-Barre syndrome is a temporary inflammation and demyelination of the peripheral nerves’ myelin sheaths, potentially resulting in axonal degeneration. Guillain-Barre syndrome results in motor weakness in a distal to proximal progression, sensory impairment, and possible respiratory paralysis. The effects of Guillain-Barre syndrome are temporary, with most patients experiencing a full recovery, and would not lead to a decrease in the patient’s bone mass.

Option 3 - Spinal stenosis
Spinal stenosis refers to a narrowing of either the vertebral or intervertebral foramina. Symptoms are typically produced as a result of mechanical compression on either the spinal cord or exiting nerve roots and may include pain, paresthesia, weakness, and diminished reflexes. Spinal stenosis is not associated with a diagnosis of osteopenia.

Option 4 - Complex regional pain syndrome
Complex regional pain syndrome is characterized by an increase in sympathetic activity causing a release of norepinephrine in the periphery and subsequent vasoconstriction of blood vessels resulting in pain and an increase in sensitivity to peripheral stimulation. Complex regional pain syndrome is not associated with a diagnosis of osteopenia.

The correct answer is Option 1.

Let’s explore the all student data:

66% of students selected Option 1, Cushing’s syndrome, the correct response
5% of students selected Option 2, Guillain-Barre syndrome
23% of students selected Option 3, Spinal stenosis
6% of students selected Option 4, Complex regional pain syndrome

System Classification
This question is an Other Systems question which represents approximately 21% of all exam items.

Content Outline Classification
This question is a Foundations for Evaluation, Differential Diagnosis, and Prognosis question which represents approximately 33% of all exam items.

Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.

Academic Focus Area
Looking to review related academic content? Pages 539, 631, and 657 from our review book PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!

Watch the video version of this Q&A episode on YouTube - https://youtu.be/B3pO7QuKm3k?si=9AFCmY106rybXAiO.