Question

Scenario:

M.S. a 72 year-old white female, Comes to your clinic for a complete physical examination. She has not been to a provider for 11 years because “I don’t like doctors.” Her only complaint today is “pain in my upper back.” She describes the pain as sharp and knife like. The pain began approximately 3 weeks ago when she was getting out of bed in the morning and hasn’t changed at all. M.S. rates her pain at about 6 of 10 point pain scale and says the pain decreases to 3 or 4 after taking “a couple of ibuprofen.” She denies recent falls or trauma.

M.S. admits she needs to quit smoking and start excising but states. “I don’t have the energy to exercise and besides, I’ve always been thin.” She has smoked one to two packs of cigarettes per day since she was 17 years old. Her last blood work was 11 years ago, and she can’t remember the results. She went through menopause at the age of 47 and has never taken hormone replacement therapy. The physical examination findings are unremarkable other than moderate tenderness to deep palpation over the spinous process at T7. No masses or tenderness to the tissue surround the tender spot. No visible masses, skin changes, or erythema are noted. Her neurological findings are intact, and no muscle wasting is noted.

Questions:

1. The Physician suspects osteoporosis. List seven risk factors associated with osteoporosis. (Learning Objective 1)
2. What Diagnostic test is most commonly used to diagnosis osteoporosis?
   (Learning Objective 2)
3. What non-pharmacological interventions will you teach M.S. to prevent further bone loss (Learning Objective 3)

Answer 1

Learning objective 1

Osteoporosis: it is a disorder of the skeleton in which bone strength becomes abnormally weak.

Risk factors includes:

1.Female gender, Caucasian or Asian race , and a family history of osteoporosis.

2.Cigarette smoking, excessive intake of alcohol and caffeine consumption, lack of exercise, and a diet which is low in calcium.

3.Poor nutrition and poor health status.

4.Malabsorption.

5.Low estrogen levels that can occur in menopause or with early removal of both ovaries surgical methods.

7.Amenorrhea in young women can also lead to low estrogen and osteoporosis.

8.Chronic diseases such as rheumatoid arthritis and chronic hepatitis C.

9.Immobility which occurs after a stroke.

10.Hyperthyroidism.

Learning objective 2:

a)Bone mineral density test: A bone mineral density test, also called as bone density test, examines segments of human bone through X-rays to detect osteoporosis.

b)Dual X-ray absorptiometry :the most common osteoporosis tests which is dual X-ray absorptiometry ,also called DXA or DEXA. It measures people’s spine, or total-body bone density to help and identify gauge their risk of fractures.

c)Bone densitometry:it is the test which is like an X-ray that quickly and accurately find outs and measures the density of bone.

Learning objective 3:

A treatment regimen that consist of both nonpharmacologic and pharmacologic interventions can be used to decrease the risk of fracture.

Nonpharmacologic interventions include:

• calcium and vitamin D supplementation.
• weight-bearing exercise.
• muscle strengthening.
• fall prevention.
• Stop smoking: smoking increases rates of bone loss and the chance of fracture in human
• Avoid excessive alcohol consumption: Consuming more than two alcoholic drinks a day might decrease bone formation and strength.