Osteoporosis: Causes, Symptoms, and Treatment

Question 1: Following her vertebral fracture at T10, the patient was prescribed alendronate and calcium. Which additional pharmacotherapeutic agent should have been prescribed? 

The patient should have also been prescribed strontium ranelate. The drug reduces fracture incidences and increases bone density. It has also been shown to have synergistic effects with bisphosphonates such as alendronate (Reginster et al., 2015). 

Question 2: At the time of her previous DEXA scans 19 months ago, was osteoporosis present in the spine, femur, and radius? 

The results of the patient’s DEXA scan 19 months ago indicate that osteoporosis had only affected the lumbar spine. The radius and the femur had not been affected yet. 

Question 3: Based on the information provided so far, which type or types of osteoporosis does this patient have? 

Primary osteoporosis Type I (postmenopausal osteoporosis). 

Question 4: Which risk factors does this patient have that have made her susceptible to bone loss? 

Age 

Family history of osteoporosis 

Small stature 

Physical inactivity 

Cigarette smoking 

History of a fracture 

The use of an anticonvulsant (phenytoin) 

Question 5: Which findings in the physical examination above are consistent with a diagnosis of osteoporosis? 

Physical examination reveals point tenderness with palpation of a bony prominence at L2. There is also appreciable lumbar lordosis and limited extension and flexion of the back. 

Question 6: Is osteopenia or osteoporosis the appropriate diagnosis in the… 

Lumbar spine – osteoporosis 

Right femoral neck – osteopenia 

Right radius – osteopenia 

Question 7: Which single laboratory test in Table 79-2 was significantly high? 

Alkaline phosphate. The patient has levels of 283 U/L against a reference range of 20 – 140 U/L. 

Question 8: Provide three reasons for this patient’s abnormal serum 25, OH-vitamin D concentration. 

The patient has signs and symptoms, and is on treatment for osteoporosis. 

The patient is on an anticonvulsant which decreases 25-hydroxyvitamin D levels (Glendenning, 2015) . 

The patient uses SPF 30 sunscreen limiting her exposure to the sunlight which is necessary for the metabolism of vitamin D (Glendenning, 2015) 

Question 9: Provide one good reason for why this patient is not taking hormone replacement therapy for vaginal dryness and hot flashes and as prophylactic therapy for post-menopausal osteoporosis. 

The patient has a family history of breast cancer (Bruyere, 2012) . Hormone replacement therapy would thus increase her risk for developing breast cancer. 

Question 10: Distinguish between lordosis and kyphosis. 

Lordosis refers to the normal inward curvature of the spine at the cervical and lumber regions. Kyphosis, on the other hand, is the normal outward curvature of the spine, particularly at the thoracic region. 

Question 11: Is this patient’s thyroid function normal or abnormal? 

The patient has a normal thyroid function since her TSH levels are within normal limits. 

Question 12: Is this patient’s parathyroid function normal or abnormal? 

The patient has normal parathyroid function since her PTH levels are within normal limits. 

Question 13: Are there any indications that this patient also has type 2 osteoporosis? 

Yes. Arguably, the reduction in bone density of the patient could be due to her age which is associated with a disequilibrium between bone resorption and bone formation. 

References 

Bruyere, H. J. (2012).  100 Case Studies in Pathophysiology . New York: Lippincott Williams & Wilkins. 

Glendenning, P. (2015). Abnormal laboratory results: Measuring vitamin D.  Australian Prescriber ,  38 (1), 12–15. https://doi.org/10.18773/austprescr.2015.004 

Reginster, J.-Y., Brandi, M.-L., Cannata-Andía, J., Cooper, C., Cortet, B., Feron, J.-M., … Rizzoli, R. (2015). The position of strontium ranelate in today’s management of osteoporosis.  Osteoporosis International ,  26 (6), 1667–1671. https://doi.org/10.1007/s00198-015-3109-y