RT Book, Section
A1 Bikle, Daniel D.
A2 Katzung, Bertram G.
A2 Vanderah, Todd W.
SR Print(0)
ID 1176468675
T1 Agents That Affect Bone Mineral Homeostasis
T2 Basic & Clinical Pharmacology, 15e
YR 2021
FD 2021
PB McGraw-Hill
PP New York, NY
SN 9781260452310
LK accesspharmacy.mhmedical.com/content.aspx?aid=1176468675
RD 2024/04/25
AB CASE  STUDYA  65-year-old  man  is  referred  to  you  from  his  primary  care  physician  (PCP)  for  evaluation  and  management  of  possible  osteoporosis.  He  saw  his  PCP  for  evaluation  of  low  back  pain.  X-rays  of  the  spine  showed  some  degenerative  changes  in  the  lumbar  spine  plus  several  wedge  deformities  in  the  thoracic  spine.  The  patient  is  a  long-time  smoker  (up  to  two  packs  per  day)  and  has  two  to  four  glasses  of  wine  with  dinner,  more  on  the  weekends.  He  has  chronic  bronchitis,  presumably  from  smoking,  and  has  been  treated  on  numerous  occasions  with  oral  prednisone  for  exacerbations  of  bronchitis.  He  is  currently  on  10  mg/d  prednisone.  Examination  shows  kyphosis  of  the  thoracic  spine,  with  some  tenderness  to  fist  percussion  over  the  thoracic  spine.  The  dual-energy  x-ray  absorptiometry  (DEXA)  measurement  of  the  lumbar  spine  is  “within  the  normal  limits,”  but  the  radiologist  noted  that  the  reading  may  be  misleading  because  of  degenerative  changes.  The  hip  measurement  shows  a  T  score  (number  of  standard  deviations  by  which  the  patient’s  measured  bone  density  differs  from  that  of  a  normal  young  adult)  in  the  femoral  neck  of  –2.2.  What  further  workup  should  be  considered,  and  what  therapy  should  be  initiated?