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PBL2
PBL2
PBL2
History
Past medical history asthma since
childhood (treated with corticosteroids aged
5055), gastric ulcer aged 45, menopause
age 59, left wrist fracture aged 67
Family history stroke in sister aged 65, hip
fracture in mother aged 78. Mother
diagnosed with osteoporosis
Social history lives alone, 2 children,
retired, smokes 5 cigarettes per day,
occasional alcohol, takes no exercise, fully
mobile and able to complete all ADLs
(activities of daily living)
Examination
On examination wrist displaced, swollen,
no open wound
No loss of sensation or vascular compromise
X-ray Colles fracture of distal radius
present
N.B. The most common osteoporotic fractures
are vertebrae, wrists, and hips. Lifetime risk
of fracture in white women is 20% for spine,
15% for wrist, and 18% for hip. There is an
exponential increase in fracture over 50
years
Bisphosphonates
Categorisati
on of
effectivenes
s for each
bisphosphon
ate we cover
Clinical
question
Different
bisphosphonates
for which we
have searched
for systematic
review or
randomised
control trial
evidence
Click on the drug of interest to see the evidence base for the
benefits and harms
Individual medicine
Thinking about this person:
Past medical history previous fracture,
postmenopausal, corticosteroid use, gastric
ulcer
We can see from the review that alendronate,
(and other bisphosphonates) are associated
with gastric ulcers and erosions
Therefore, we should consider other options,
but remember as well that this is not a
contraindication, but a caution about their use
Conclusions
Risks of HRT outweigh the benefits
We dont know if exercise is beneficial
Monotherapy with calcium or vitamin
D has not been shown to reduce
fractures
Bisphosphonates are effective but are
associated with gastric ulcers
Raloxifene increases stroke risk