solved

Mrs. Davis presented to the clinic in December of 2010 with some concerns about osteoporosis. She was becoming more stooped and had already lost 1″ in height over the last few years. She was 20 years postmenopausal and had never taken hormone replacement therapy. She subsequently received a DEXA scan at that time and was placed on Fosamax 10 mg daily. Over the next year, this seemed to be working well for 1 her and she did not experience any side effects from the medication. In the fall of 2011, she sustained a fracture to her 4th metacarpal on her left hand that she suffered during a fall. She received another DEXA scan in late 2011 with no change. She seemed fairly stable and was only seen yearly after that time. During a repeat exam in 2013, DEXA scores continued to show progression and she was subsequently referred to an endocrinologist to eliminate secondary causes. After a thorough work-up, no cause was found for her worsening osteoporosis. Thyroid studies were normal as well as serum phosphorus, PTH and urine calcium. A suggestion was made to switch to weekly Fosamax; however, this was not tolerated well and she remains on Fosamax 10 mg q.d. Family and Social History: Mother died at age 40 (CA); Father died at age 57 (CAD); Brother w/ CAD, age 79; Twin sister with osteoporosis and depression. Patient is very active; she walks 1-2 miles/day. She stopped smoking 30 years ago, has an occasional drink. She also drinks a cup of coffee a day. She reports diarrhea and gas with dairy products so avoids them. Current Health Status/Summary of Current Problems: Mrs. Davis is in the clinic today for a follow up visit for her osteoporosis. She reports increased pain in her back and ribs at times, for which she takes additional aspirin. She also reports feeling weak at times with occasional muscle cramps in her legs. She is 5’2″ (2010 height 5’4″) and 113 lbs. 1.Identify and discuss at least 6 risk factors in Mrs. Davis’ history that predispose her to osteoporosis. Which of those risk factors are intrinsic and not amenable to change? Which are extrinsic and can be modified? 2.Evaluate her calcium intake from her diet and supplements; is it adequate for her age and menopausal status? 3.Formulate a recommendation for vitamin and mineral intake for Mrs. Davis, taking into consideration her lactose intolerance. 4. Evaluate Mrs. Davis’ level of physical activity and make any recommendations you think necessary

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