Chapter 48: Osteoporosis
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?
a. SD has osteopenia and should be started on alendronate 70 mg po every week.
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.
c. SD is young and should be started on teriparatide 20 μg SQ qd to rebuild her bone mass to more normal levels.
d. SD should be started on calcium 1000 mg and vitamin D 800 IU qd.
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.
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.
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).
Answer c is incorrect. Teriparatide is recommended for patients with (severe) osteoporosis with high risk of fracture, not osteopenia.
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?
a. JR should have a BMD checked immediately to determine if he has osteoporosis.