Managing Osteoporosis in a 56-Year-Old Woman
Discover the case of a 56-year-old woman with osteoporosis who had a significant decline in spine bone mineral density despite adherence to alendronate. Explore her history, recent DXA scans, lab results, and treatment options, including recommendations for calcium supplementation, resistance training, and decisions regarding bisphosphonate therapy. Choose the best course of action to optimize bone health and reduce fracture risk.
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Presentation Transcript
CASE A 56-year-old woman with a history of osteoporosis. She referred after a recent DXA scan showed a significant decline in spine bone mineral density. She had appropriate adherence to alendronate, 70 mg weekly, for the last 3 years. The bone mineral density of her hips is in the osteopenic range and has remained stable. Her last menstrual period was 5 years ago. She has had 2 fractures before the initiation of therapy, both of which were trauma related. Family history: her mother has osteoporosis and a history of a hip fracture and her maternal grandmother sustained a hip fracture in her 80s
The patient's most recent DXA scan is shown, and this was compared with her previous DXA scan performed 2 years earlier . The findings in the spine are consistent with osteoporosis and Compared with the previous study, the lumbar spine bone density has decreased by 6%, representing a significant change.
Laboratory test results: Total calcium = 9.7 mgldL (8.2-10.2 mgldL) vitamin D = 31 nglmL (25-80 nglmL Phosphorus = 3.5 mgldL (2.3-4.7 mgldL) PTH = 35 pglmL (10-65 pglmL) Creatinine = 0.6 mgldL (0.6-1.1 mgldL) Albumin = 3.4 gldL (3 .5-5.0 gldL) TSH = 1.6 mlU/L (0.5-5.0 mIUlL) Urinary N-Ielopeplide = 8 nmol BCE/mmol creal (6.2- 19.0 nmol BCE/mmol creal)
In addition to calcium and vitamin D supplementation and a resistance-training program, which of the following additional recommendations should you make? A. Discontinue the oral bisphosphonate and prescribe intravenous zoledronic acid B. Discontinue the oral bisphosphonate and prescribe a weekly combined estrogen-progestin patch C. Discontinue the oral bisphosphonate and prescribe teriparatide D. Recommend a drug holiday and follow-up DXA scan in 3 to 5 years E. Continue the oral bisphosphonate and order another DXA scan
