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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Identify risk factors that predispose patients to osteoporosis

  • Recommend appropriate lifestyle modifications to prevent bone loss

  • Compare and contrast the effect of available treatment options on reduction of fracture risk

  • Recommend an appropriate treatment regimen for a patient with osteoporosis and develop a monitoring plan for the selected regimen

  • Educate patients on osteoporosis and drug treatment, including appropriate use, administration, and adverse effects

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PATIENT PRESENTATION

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Chief Complaint

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"I am here to see my new doctor."

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History of Present Illness

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DS is a 72-year-old Caucasian woman who presents to the internal medicine clinic to establish care at the urging of her daughter. She had been followed for a number of years by her previous physician who recently retired. She reports she has been taking calcitonin nasal spray for the past 5 years when her doctor ordered a bone density test. She remembers asking her physician if she should take aldendronate instead because she knew several women in her book club who took the medication. She reports they discussed it but he felt calcitonin may be a better choice due to her loss of height and presence of heartburn. She tries to walk on a regular basis for exercise but finds that her speed and distance are not what they used to be since her hip was replaced 6 months ago. She reports consuming milk on a daily basis with her cereal. She only rarely takes in other dairy products. She drinks 5–6 cups of coffee daily and has been a heavy coffee drinker all of her life. She has had problems with heartburn "on and off" over the years. She currently takes omeprazole for her heartburn and feels that her symptoms are well controlled.

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Past Medical History

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Osteoporosis status post (s/p) vertebral fractures and left hip fracture with hip replacement 6 months ago

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Gastroesophageal reflux disease (GERD) × 20 years

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Hypertension × 5 years

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Peripheral artery disease (PAD) (Duration: 3 years)

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Hypothyroidism × 21 years

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Nicotine dependence × 55 years

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Osteoarthritis s/p total knee replacement 10 years ago

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S/p deep venous thrombosis (DVT) after knee surgery 10 years ago

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Family History

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Father deceased at age 94 due to cancer (type unknown). Mother deceased at age 92, history of hip fracture. She has one brother and one sister who are both healthy.

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Social History

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Married and lives with her husband of 44 years; has 5 children. She is a retired social worker.

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Tobacco/Alcohol/Substance Use

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Social drinker; (+) tobacco 1 ppd × 54 years, (−) illicit drug use

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Allergies/Intolerances/Adverse Drug Events

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