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Chief Complaint

“I guess I need meds for my bad bones.”

History of Present Illness

Mr. Smith is a 72-year-old male presenting to your pharmacotherapy clinic for management of his chronic disease states, including osteoporosis. Mr. Smith has a history of intolerance to bisphosphonate therapy, so his primary care provider has asked for your assistance with choosing appropriate treatment for him.

Student Work-Up

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Missing Information?


Patient Database

Drug Therapy Problems

Care Plan (by Problem)


  1. What risk factors does Mr. Smith have for osteoporosis?

    Hint: See Table 57-1 and Clinical Presentation and Diagnosis in PPP

  2. Explain how Mr. Smith meets criteria for pharmacologic treatment for prevention of osteoporotic fractures.

    Hint: See Figure 57-2 and TREATMENT in PPP

  3. What are non-pharmacologic recommendations for Mr. Smith?

    Hint: See Treatment in PPP

  4. Which pharmacotherapy option(s) do you recommend for Mr. Smith?

    Hint: See Treatment in PPP

  5. What monitoring parameters do you recommend?

    Hint: See Treatment in PPP


If the patient’s vitamin D level returns at 22 ng/mL, what do you recommend for Mr. Smith?

Hint: See Treatment in PPP


Global Perspective

Osteoporosis is a common disorder characterized by a decrease in bone strength while increasing the risk of bone fracture. It is associated with significant morbidity and mortality in both men and women. Although osteoporotic fractures are more common in women, more than 30% of all fractures occur in men and the mortality rate for hip fractures is higher in this population. The risk of fracture increases significantly in women after the onset of menopause, while in men the increase occurs approximately 10 years later. Both women and men should be evaluated for osteoporosis and high-risk patients should be treated with appropriate therapies considering safety, efficacy, and adherence.

Key References

1. +
Cosman  F, de Beur  SJ, Lewiecki  EM,  et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25:2359–2381.  [PubMed: 25182228]
2. +
Watts  NB, Adler  RA, Bilezikian  JP,  et al. Osteoporosis in men: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012 June;97(6):1802–22.  [PubMed: 22675062]
3. +
Camacho  PM, Petak  SM, Binkley  N,  et al. American Association of Clinical Endocrinologists and American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis—2020 update. Endocr Pract. 2020;26(suppl 1):1–46.  [PubMed: 32427503]

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