CASE STUDY 'OSTEOPOROSIS ' L For the Disease Summary for this case study, see the CD-ROM. \TIENT Cmh e i O > w “I've had back pain now for more than 5 weeks and I can'’t stand it anymore. I've tried extra- strength ibuprofen, naproxen, and acetaminophen, and I've visited a chiropractor, but I don't get any long-term relief.” mmm History of Present lllness Mrs. LA. is a very pleasant 63-year-old white woman of slight stature who has been referred to an orthopedic specialist by her PCP. She has been experiencing insidious back pain for 5-6 ‘ weeks. OTC analgesics provide temporary relief, but the pain is otherwise constant and aggravated by activity. She denies any obvious acute injury to her back, although she reports 1 that she had a case of the flu with a prolonged and severe cough approximately one month ago. She also reports a vertebral fracture approximately five years ago. The patient has been an avid gardener for many years. Following the death of her hus- band 18 months ago, she has continued to live in her house and do all the household chores. Since her back pain began, she has been limited in her ability to do her household chores ‘ and gardening. mmm Past Medical History | | The patient entered natural menopause at 52 years and has never used hormone replacement ! therapy. Currently, she has mild hot flashes and vaginal dryness. At age 58, she suffered a verte- i bral fracture at T10 by simply carrying a shopping bag. DEXA scans conducted at that time revealed the onset of osteoporosis. Her bone mass density T-scores at that time were: —3.33 lumbar spine, —2.24 right femoral neck, and —2.44 right radius. These scans represented a 6.1%, 6.9%, and 6.2% decrease in bone mass density in the previous 19 months in the lum- bar spine, right femoral neck, and right radius, respectively. Her serum calcium concentra- tion was low-normal at 8.5 mg/dL and serum alkaline phosphatase level was moderately increased at 290 TU/L. She was prescribed alendronate and a calcium supplement daily. The patient was diagnosed with a seizure disorder at age 22 years and is currently well controlled with phenytoin. She has had asthma since childhood. Her current asthma med- \ ications include a‘bronchodilator that she uses when needed, a daily steroid inhaler, and an ; | |