Chapter 56. Osteoporosis
RW is a 45-year-old African-American woman with an 18 pack–year smoking history who quit 10 years ago and has a BMI of 32 kg/m2. She is currently on a 1-week prednisone taper for an asthma exacerbation and takes lisinopril 20 mg daily for hypertension. Which characteristic is associated with an increased risk of developing osteoporosis?
A. African American ethnicity
B. Presence of hypertension
C. Present systemic oral glucocorticoid therapy
E. BMI greater than 30 kg/m2
You are a pharmacist involved in bone density screening during a health fair in your community. Several patients present to your booth for a peripheral bone density measurement. Based on the following descriptions and recommendations from the National Osteoporosis Foundation, who should be referred to a health care provider for follow-up and evaluation of bone mineral density by central DXA?
A. 71-year-old man with low bone mineral density
B. 66-year-old woman with low calcium intake and nicotine dependence
C. 53-year-old active African-American man receiving chronic glucocorticoid therapy
D. 58-year-old woman with a FRAX 10-year probability of hip fracture of 3.2%
E. All of these patients meet criteria for screening by central DXA.
MM is an 82-year-old frail woman who is recovering from a vertebral compression fracture. At her follow-up appointment today, her primary care provider has asked the team to make interventions to reduce her fall risk. Which factor would decrease her risk of falls?
A. Discontinuation of oxybutynin
B. Changing amitriptyline to diphenhydramine for sleep
C. Use of lorazepam several nights per week
D. Initiation of metoprolol
E. Tapering of nonsteroidal anti-inflammatory agents
RS is a 75-year-old woman with newly diagnosed osteoporosis who is being discharged from the hospital after total hip replacement due to hip fracture. She has never taken any medication for osteoporosis. Her history is significant for GERD, DVT associated with oral contraceptive use 20 years ago, and family history of breast cancer. Which therapy may offer the most benefit in this patient?
A. Denosumab 60 mg subcutaneously every 6 months