Osteoporosis

HISTORY:

Presents for a ‍newly diagnosed osteoporosisabnormal BMDfragility fracture

Fragility fractures: ‍none, ‍humeral head, ‍wrist, ‍dorsolumbar spine, ‍hip, ‍



Test results:

BMD: ‍normalosteopeniaosteoporosis, T-score ‍

FRAX score (10-year risk): hip fracture ‍‍%, major osteoporotic fracture ‍‍%



Associated symptoms: *Try using right-click for negatives*

‍bone pain

‍back pain

‍limited mobility

‍loss of height

‍kyphosis

‍difficulty walking



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍

Musculoskeletal: joints ‍ ‍normal, ‍no limited ROM



ASSESSMENT:

‍Osteoporosis ‍likelysuspectedpossible

DDx: ‍



PLAN:

- FRAX score calculation

- Blood work: ‍CBC, ‍creatinine, ‍electrolytes, ‍TSH, ‍calcium, ‍phosphate, ‍albumin, ‍vitamin D, ‍PTH, ‍alkaline phosphatase, ‍serum protein electrophoresis, ‍testosterone, ‍FSH, ‍LH, ‍prolactin, ‍anti-transglutaminase

- Urine: ‍24-hour urine calcium

- Bone mineral density test

- X-ray of spine

- ‍Vitamin D supplements

- ‍Calcium supplements

- ‍Bisphosphonates

- ‍Denosumab (

- ‍Teriparatide

- ‍Raloxifene

- ‍Hormone replacement therapy

- Increase dietary intake of vitamin D-rich and calcium-rich foods (milk, yogurt, cheese, sardines, salmon, tofu, almonds, spinach, kale, broccoli)

- Weight-bearing exercises

- Limit alcohol intake

- Avoidance of smoking

- Fall prevention measures

- Consider stopping biphosphonates after 5 years of treatment if BMD is stable and no new fractures

- Repeat bone mineral density test in ‍1235 ‍years

- Referral to endocrinologist

- Follow-up in ‍ ‍monthsyears

- Return if new symptoms develop such as back pain, height loss, or fractures