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

  • Identify the risk factors for the development of osteoporosis and use the FRAX tool to assess risk of an osteoporotic fracture.

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

  • Recommend appropriate calcium 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.


Chief Complaint

“I am anxious 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.”


Beverly Farland is a 65-year-old Caucasian woman with a history of COPD, 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 has to stop after 15 minutes because she is out of breath. She admits that she has a hard time remembering to take her medications faithfully. She states she uses her Combivent inhaler approximately twice a day and takes her medicines “most of the time.”


  • Hypothyroidism × 5 years

  • COPD (GOLD 2) diagnosed one year ago and currently stable; no history of COPD exacerbations

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

  • Menopause at age 51

  • GERD


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

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


Married; G2P3; 1 ppd smoker; drinks occasionally


Reports vaginal dryness; has noticed that her height has decreased by 2″ since she was “in her prime;” reports shortness of breath with exercise; denies headache, chest pain, GI pain, or heartburn


  • Combivent Respimat 1 inhalation four times daily

  • Omeprazole 20 mg PO once daily × 1 year

  • Synthroid 75 mcg PO once daily × 5 years



Physical Examination


WDWN Caucasian woman in NAD


  • Today:

  • BP initially 158/96 mm Hg, Repeated at end of office visit 133/88 mm Hg, P 70 ...

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