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Chapter 48: Osteoporosis
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SD is a 45-year-old woman. She does not have any significant past medical history and currently smokes one-half pack a day and drinks alcohol socially. She attends a health fair and learns her T-score is −1.5. Which is the best course of action?
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a. SD has osteopenia and should be started on alendronate 70 mg po every week.
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b. SD has no physical signs or symptoms of osteoporosis and should be advised to quit smoking and to have her BMD checked again in 6 months.
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c. SD is young and should be started on teriparatide 20 μg SQ qd to rebuild her bone mass to more normal levels.
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d. SD should be started on calcium 1000 mg and vitamin D 800 IU qd.
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Answer d is correct. SD is not currently taking calcium or vitamin D per WHO guidelines. Though this may or may not fully explain her low BMD score, it is the most logical starting point to minimize the risk of developing osteoporosis.
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Answer a is incorrect. While SD does have osteopenia based on the WHO guidelines, it would be prudent to do a more thorough assessment before initiating a bisphosphonate at this point. Furthermore, if a bisphosphonate is ultimately deemed appropriate, the “prevention” dose of alendronate is 5 mg po qd or 35 mg po every week.
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Answer b is incorrect. Osteoporosis, as well as osteopenia, is often asymptomatic and a lack of symptoms does not justify withholding therapy. It should be recommended that SD go for a more thorough assessment and be advised to quit smoking, as this is a risk factor. However, repeating a BMD is generally not recommended more than every other year per the National Osteoporosis Foundation (NOF).
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Answer c is incorrect. Teriparatide is recommended for patients with (severe) osteoporosis with high risk of fracture, not osteopenia.
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JR is a 58-year-old white man who presents to the ED with a hip fracture after rolling out of his bed in his home. His vitals and laboratory values are unremarkable. He is 5 ft 8 in and weighs 133 lb. His medical history includes mild asthma and rheumatoid arthritis. His current medications include albuterol inhaler every 4 to 6 hours as needed, prednisone 10 mg daily, and a multivitamin. After discharge from the hospital, he is sent to your clinic about 3 weeks later for further evaluation. Which of the following is the best answer?
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a. JR should have a BMD checked immediately to determine if he has osteoporosis.
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