Case Study #79
Osteoporosis
Case Study:
1. Following her vertebral fracture at T10, the patient was prescribed alendronate
and calcium. Which additional pharmacotherapeutic agent should have been
prescribed?
Strontium ranelate (taken orally every day) can be given to women with osteoporosis and
vertebral fractures. Strontium reduces fracture incidence by 40% and increases bone
density in the lumbar spine and neck of the femur.
2. At the time of her previous DEXA scans 19 months ago, was osteoporosis present in
the spine, femur, and radius?
Based on the results of her DEXA scan 19 months ago osteoporosis was only present in
the lumbar spine and not in the femur or the radius.
3. Based on the information provided so far, which type or types of osteoporosis does
this patient have?
Type 1.
4. Which risk factors does this patient have that have made her susceptible to
bone loss?
Age, family history of osteoporosis, her small size, and her physical inactivity. Her
medications could also make her more susceptible to osteoporosis.
5. Which findings in the physical examination above are consistent with a diagnosis
of osteoporosis?
Point tenderness with palpation of bony prominence at L2, limited flexion and extension
of the back, and significant lumbar lordosis.
6. Is osteopenia or osteoporosis the appropriate diagnosis in the…
a. Lumbar spine – osteoporosis
b. Right femoral neck – osteopenia
c. Right radius – osteopenia
7. Which single laboratory test in Table 79-2 was significantly high?
Alkaline phosphate.
8. Provide three reasons for this patient’s abnormal serum 25, OH-vitamin
D concentration.
One reason could be that the patient needs to have more vitamin D in her diet, milk with
breakfast and cheese a few times a week is not sufficient. Another reason could be the
sunscreen that the patient is wearing outside; this could be blocking the vitamin D that
the sun’s rays provide. Another reason could be prednisone that he patient has been
taking for her asthma. This could be inhibiting vitamin D absorption.
Osteoporosis
Case Study:
1. Following her vertebral fracture at T10, the patient was prescribed alendronate
and calcium. Which additional pharmacotherapeutic agent should have been
prescribed?
Strontium ranelate (taken orally every day) can be given to women with osteoporosis and
vertebral fractures. Strontium reduces fracture incidence by 40% and increases bone
density in the lumbar spine and neck of the femur.
2. At the time of her previous DEXA scans 19 months ago, was osteoporosis present in
the spine, femur, and radius?
Based on the results of her DEXA scan 19 months ago osteoporosis was only present in
the lumbar spine and not in the femur or the radius.
3. Based on the information provided so far, which type or types of osteoporosis does
this patient have?
Type 1.
4. Which risk factors does this patient have that have made her susceptible to
bone loss?
Age, family history of osteoporosis, her small size, and her physical inactivity. Her
medications could also make her more susceptible to osteoporosis.
5. Which findings in the physical examination above are consistent with a diagnosis
of osteoporosis?
Point tenderness with palpation of bony prominence at L2, limited flexion and extension
of the back, and significant lumbar lordosis.
6. Is osteopenia or osteoporosis the appropriate diagnosis in the…
a. Lumbar spine – osteoporosis
b. Right femoral neck – osteopenia
c. Right radius – osteopenia
7. Which single laboratory test in Table 79-2 was significantly high?
Alkaline phosphate.
8. Provide three reasons for this patient’s abnormal serum 25, OH-vitamin
D concentration.
One reason could be that the patient needs to have more vitamin D in her diet, milk with
breakfast and cheese a few times a week is not sufficient. Another reason could be the
sunscreen that the patient is wearing outside; this could be blocking the vitamin D that
the sun’s rays provide. Another reason could be prednisone that he patient has been
taking for her asthma. This could be inhibiting vitamin D absorption.
