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Chapter 49. Osteoporosis

SD is a 55-year-old woman with no significant past medical history. However, she currently smokes one pack a day and drinks alcohol socially (2 beers every other week). She attends a health fair and learns her T-score is −1.5. Which statement represents the best course of action for the patient?

a. SD has osteopenia and should be started on alendronate 70 mg po every week.

b. SD should be advised to quit smoking and to have her BMD checked again in 6 months.

c. SD should be started on teriparatide 20 mcg SQ daily to rebuild her bone mass to normal levels.

d. SD should be started on calcium 1200 mg po daily and vitamin D 800 IU po daily.

Answer d is correct. SD is not currently taking calcium or vitamin D per World Health Organization (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. She should be referred for further testing (ie, DXA).

Answer a is incorrect. It is unknown if SD does or does not have osteopenia based on the WHO guidelines, as a heel ultrasound cannot be used for diagnostic purposes. Therefore, 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 daily or 35 mg po every week.

Answer b is incorrect. It should be recommended that SD go for a more thorough assessment and be advised to quit smoking, as active or previous smoking 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. SD should be referred for further assessment to determine her condition based on WHO guidelines.

JR is a 58-year-old white man who presents to the emergency department with a hip fracture after rolling out of his bed in his home. He is 5' 8" and weighs 133 lb. His medical history includes rheumatoid arthritis, currently treated with prednisone 10 mg daily (× 2 years), methotrexate 15 mg weekly (× 2 years) and folic acid 1 mg daily (× 2 years). Which statement represents the best course of action for the patient?

a. JR should have a BMD checked immediately to determine if he has osteoporosis.


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