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LEARNING OBJECTIVES

After completing this case study, the reader should be able to:

  • Identify the risk factors for the development of osteoporosis and use the Fracture Risk Assessment Tool (FRAX) to assess risk of an osteoporotic fracture.

  • Recommend appropriate nonpharmacologic measures for the prevention and treatment of osteoporosis.

  • Recommend appropriate calcium and vitamin D supplementation required for the prevention and treatment of osteoporosis.

  • Design an appropriate pharmacologic treatment regimen for the treatment of osteoporosis in postmenopausal women.

  • Provide patient education regarding osteoporosis and its therapy.

  • Discuss the role that the fracture liaison service plays in coordinating care and preventing additional fractures.

PATIENT PRESENTATION

Chief Complaint

“I recently fell while walking my dog Ruby, and my lower back is sore. I would also like to get the results of my DXA scan. My mother is still undergoing rehabilitation in the nursing home after her hip fracture three weeks ago. I’ve heard osteoporosis can run in families, and I don’t want to experience what she is going through.”

HPI

Betsy Fritsch is a 65-year-old Caucasian woman with a history of hypertension, hypothyroidism, and GERD. She presents to the family medicine clinic for her yearly physical and to discuss the results of her recent labs and DXA scan.

In an effort to become more active, she recently started walking around her neighborhood every day but fell 3 days ago and injured her back. She admits that she has a hard time remembering to take her medications faithfully. She states she takes her medicines “most of the time.” She states that she was prescribed alendronate 2 years ago but that she is “afraid of its side effects” and did not start it.

PMH

Hypothyroidism × 5 years

Hypertension

Breast cancer with mastectomy of left breast and radiation therapy at age 45

Menopause at age 51

GERD with history of esophageal stricture

FH

Paternal history (+) for hypertension; father died in his sleep at age 80

Maternal history (+) for stroke and vascular disorders; hip fracture

SH

Married; G2P2; drinks occasionally, retired real estate agent, lives independently with her husband and dog, manages her own medicines, completed college, does not have a Medicare Part D plan

Meds

Omeprazole 20 mg PO once daily × 1 year

Levothyroxine sodium (Synthroid) 75 mcg PO once daily × 5 years

Hydrochlorothiazide 25 mg PO once daily

All

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