Case Study: Osteoporosis

1. What are some main risk factors for osteoporosis?

Women.
Increased age.
White or of Asian descent.
Parent or sibling with h/o osteoporosis.
FHx of hip fractures.
Small body frame.
CA tx (women can experience drop in estrogen, men can experience drop in testosterone with prostate CA tx).
Drop in testosterone with age (men).
Menopause (decreased estrogen).
Hyperthyroidism (can be due to overactive thyroid or iatrogenic 2/2 excess hypothyroid tx).
Hyperactive parathyroid glands.
Hyperactive adrenal glands.
Low calcium intake.

2. Which main risk factors does this patient have?

Female.
Increased age (71 y/o).
White.
Small frame (50 110 lbs).
Mom has h/o osteoporosis.
Mom has h/o hip fracture.
3. What are some classes of medications that can contribute to mineral loss associated with osteoporosis? (Name 5). Is
this patient on any medications that could be contributing? (Y or N, name them).
Corticosteroids (prednisone, cortisone).
Anticonvulsants.
Depression meds.
GERD meds. Yes, pt is on Nexium.
Chemotherapy. Yes, pt is on Femara for breast CA.
Transplantation rejection meds.
Thyroid meds. Yes, pt is on Synthroid.
4. What are some secondary causes of osteoporosis and which ones does this patient have? (Medical conditions, lifestyle
or dietary factors, etc.)
Sedentary lifestyle.
Low calcium intake.
Rheumatoid arthritis.
Eating disorders (e.g. anorexia).
GI Sx (causing decreased absorption of calcium).
Excessive alcohol consumption (>2 drinks of EtOH/day).
Patient has:
Tobacco use smokes PPD for 40 years.

5. What are some nutritional causes of osteoporosis?

Low calcium intake.
Anorexia nervosa.
Bulimia.
Excessive EtOH consumption.
6. Which nutritional supplements is the patient on and which other nutritional deficiencies could be potentially
contributing to her diagnosis?
Pt currently taking calcium supplement and multivitamin.
It is unknown if pt is anorexic.
7. Any medicines or supplements above that could be stopped or switched with a different medication for this patients
condition?
Physician could recheck T3, T4 levels to determine if further Synthroid tx is necessary. If unnecessary, pt could have
Synthroid tx stopped to reduce hyperthyroid state.

8. What is the class of medications that is used for the prevention and treatment of osteoporosis?
Bisphosphonates acts to inhibit osteoclast-mediated bone resorption.
Pt is currently on Fosamax, which is a bisphosphonate.

Osteoporosis facts:
Disease characterized by reduced bone mass and increased skeletal fragility that leads to an increased risk in fractures
(particularly of hip, spine and wrist)
Caused by an imbalance between new bone formation and old bone resorption
Leading cause of osteoporosis is lack certain hormones: estrogen (women), testosterone (men)
Affects 10 million Americans (another 34 at risk for it)
Sxs:
Early in course: asymptomatic
Onset of pain: dull pain in bones or muscles, particularly LBP or neck pain
Later in course: sharp pains may come on suddenly, that can be made worse by activity that puts weight on the
area. May be accompanied by tenderness and generally begins to subside in one week. Pain may linger more than three
months.
Spinal compression fractures result in loss of height with a stooped posture (aka dowagers hump)
Fractures at other sites, commonly the hip or bones of the wrist, usually result from a fall