Osteoporosis

Bone Up on Osteoporosis (Level II)

PATIENT PRESENTATION
Chief Complaint
"My back has been hurting a lot since yesterday."

HPI
Beverly Jones is a 75-year-old Caucasian woman with a history of HTN, hyperlipidemia, COPD,
hypothyroidism, and osteoporosis. She presents to the family medicine clinic for a follow-up
visit for her HTN and osteoporosis. She has been experiencing episodes of constipation and
flatulence since she began taking Os-Cal 500 after her last clinic visit.

PMH
HTN first diagnosed at age 50.

S/P MI 12 years ago.

Hyperlipidemia x 13 years; patient modified diet and took cholestyramine for several
years.

Hypothyroidism x 27 years, treated with levothyroxine.

Osteoporosis diagnosed by DXA scan 2 years ago.

COPD diagnosed several years ago. History of repeated exacerbations requiring

prednisone; last exacerbation 6 months ago. Currently stable on multiple inhalers.

Breast cancer with mastectomy of left breast and radiation therapy at age 40.

Menopause at age 39.

Right carotid endarterectomy 2 years ago.

GERD.

FH
Paternal history (+) for CAD; father died at age 60 of "heart trouble." Maternal history (+) for
stroke and vascular disorders; mother became menopausal at approximately age 40.

SH
Widowed; G2P3; 21/2 ppd smoker, quit after MI; non-drinker

ROS
Mild headaches and new onset back pain, treated with acetaminophen; vaginal dryness; has
noticed that her height has decreased by 2'' since she was 35 years old; denies shortness of
breath or chest pain

Meds
Ramipril 10 mg po BID x 2 years

Tiotropium 18 mcg inhaled once daily x 9 months

Advair 250/50 1 puff BID x 9 months

Albuterol MDI 2 puffs Q 6 h PRN

Synthroid 100 mcg po once daily x 20 years

Atenolol 50 mg po once daily x 10 years

Aspirin 81 mg po once daily x 12 years

Omeprazole 20 mg po once daily x 1 year

Lipitor 10 mg po once daily x 3 months

Os-Cal 500 po TID x 3 months

All
NKDA

Physical Examination
GEN
WDWN Caucasian woman in NAD

VS
BP 150/94, P 64, RR 17, T 37°C; Wt 53.5 kg, Ht 5'3''

SKIN
Fair complexion, color good, no lesions

HEENT
PERRLA; EOMI; eyes and throat clear; funduscopic exam reveals mild arteriolar narrowing,
with AV ratio 1:3; no hemorrhages, exudates, or papilledema

NECK/LYMPH NODES
Supple, without obvious nodes; no JVD

CHEST
Decreased breath sounds bilaterally; air movement decreased; no rales or rhonchi

BREASTS
Mastectomy scar left breast; right breast normal

CV
RRR; no murmurs; normal S1 and S2, no S3 or S4

ABD
Soft, NT/ND, (+) BS

GENIT/RECT
Deferred

MS/EXT
Good pulses bilaterally

NEURO
CN II–XII intact; DTRs 2+; sensory and motor levels intact

Labs
Na 141 mEq/L TSH 3.492 mIU/L Current fasting lipid profile:   Three months ago:  

K 4.2 mEq/L AST 32 IU/L   T. chol 250 mg/dL

Cl 104 mEq/L ALT 27 IU/L   T. chol 177 mg/dL   Trig 265 mg/dL

CO2 25 mEq/L     Trig 215 mg/dL   HDL 30 mg/dL

 

BUN 17 mg/dL     HDL 32 mg/dL   LDL 167 mg/dL

SCr 1.0 mg/dL     LDL 102 mg/dL   AST 20 IU/L

Glu 98 mg/dL       ALT 17 IU/L

Other
DXA scan of lumbar spine today reveals: L2–4 = 0.780 g/cm 2 (T score: –3.2 SD);
right femoral neck = 0.615 g/cm2 (T score: –3.1 SD)

X-ray of the spine today shows a new compression fracture on L3