Question

Assessment:

Chief Complaint: 72-year-old woman who fell on her right hip.

History: 72-year-old white female, was brought to the Emergency Room after falling. She was previously in good health, despite leading a relatively sedentary lifestyle and having a 30-year history of cigarette smoking. The only medication she currently takes is propranolol for mild hypertension. She fell upon entering the bathtub when her right leg slipped out from under her; she landed on her right hip. There was no trauma to her head, nor does she complain of right or left wrist pain. However, she reports severe pain in the right hip and upper thigh and was unable to get up after her fall.

Physical examination: A/O x4, and was responding appropriately to questions despite being in considerable pain. There were no signs of trauma to the head, neck, torso, arms or left leg. The right thigh and hip were extremely tender and were immobilized by a leg splint. Heart and lung sounds were normal and abdominal sounds were reduced.

Radiology report: The X-ray of the right hip revealed a complete, comminuted, intertrochanteric fracture of the right hip. There were also long-term osteoporotic changes in the femur, tibia, and fibula.

Surgery: ORIF to the right hip

Following her recovery, she was placed on three medications: oral calcium supplements, oral estrogen, and oral alendronate sodium.  

Question:

1.    Why do bones become osteoporotic in some people?

2.    How does weight-bearing exercise influence the bone healing process?

3.    What risk factors does she have for osteoporosis?

4.    What bones are most vulnerable to osteoporosis and why?

5.    How does each of these medications work to treat the patient?

Thanks

Answer 1

1.    Why do bones become osteoporotic in some people?

Osteoporosis is more likely to occur in people who have:

• Low calcium intake. A lifelong lack of calcium plays a role in the development of osteoporosis. Low calcium intake contributes to diminished bone density, early bone loss and an increased risk of fractures.
• Sex hormones. Lowered sex hormone levels tend to weaken bone. The reduction of estrogen levels in women at menopause is one of the strongest risk factors for developing osteoporosis.

2.    How does weight-bearing exercise influence the bone healing process?

Weight-bearing exercise can help to slow bone loss, and several show it can even build bone. Activities that put stress on bones stimulate extra deposits of calcium and nudge bone-forming cells into action. The tugging and pushing on bone that occur during strength and power training provide the stress. The result is stronger, denser bones.

3.    What risk factors does she have for osteoporosis?

1. Female gender,  thin and small body frames.
2. Cigarette smoking (reduces estrogen levels)
3. Older women who are past menopause

4.    What bones are most vulnerable to osteoporosis and why?

Osteoporosis affects the entire skeleton, but the spongy bone of the spine is most vulnerable. For this reason, compression fractures of the vertebrae are common in people with osteoporosis. Osteoporosis-related fractures most commonly occur in the hip, wrist or spine.

5.    How does each of these medications work to treat the patient?

Oral estrogen

Estrogen is a sex hormone that is essential to female bone health because it promotes the activity of osteoblasts, which are cells that produce bone. When estrogen levels drop during menopause, the osteoblasts aren't able to effectively produce bone.

Estrogen replacement therapy used to be the only FDA-approved treatment to prevent osteoporosis. There are now many other drugs and medications for osteoporosis, but estrogen remains a fairly common treatment to conserve bone mass and prevent osteoporosis-related fractures in post-menopausal women.

Calcium suppliments

Many clinical trials have now been carried out to determine whether calcium supplements can improve bone density and reduce fractures. There is consistent evidence that the use of calcium supplements reduces bone turnover by about 20%, and this is associated with a reduction in postmenopausal bone loss.

oral alendronate sodium

This medication works by slowing bone loss. This effect helps maintain strong bones and reduce the risk of broken bones (fractures). Alendronate belongs to a class of drugs called bisphosphonates.