1 / 7

Osteoporosis Management: Clinical scenario

Osteoporosis Management: Clinical scenario. Status. Medical History. Medical History. Women, 49 y Asymptomatic - BMD T-scores: -2.7. Menopause: 45y Mother : hip fracture at age of 79 y. Further examination? . Spinal X-ray? . Normal . Rx?. Vertebral fx . Case 1. Yes

faith
Télécharger la présentation

Osteoporosis Management: Clinical scenario

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Osteoporosis Management:Clinical scenario

  2. Status Medical History Medical History • Women, 49 y • Asymptomatic • - BMD T-scores: -2.7 • Menopause: 45y • Mother : hip fracture • at age of 79 y Further examination? Spinal X-ray? Normal Rx? Vertebral fx Case 1 Yes Differentiation: Secondary osteoporosis (Hypogonadism, thyroidism…) Yes Maybe asymptomatic vertebral fracture (deformity) No Because the risk for the patient sustaining a fracture in the next 10 y is low Yes Because the risk for a subsequent fx is high Anti-resorption (alendronate, risedronate or raloxifene) Rx?

  3. Status Medical History Medical History • Women, 55 y • Asymptomatic • - BMD T-scores: -1.5 • Normal Further examination? Spinal X-ray? Normal Rx? Rx? Vertebral fx Case 2 NO Considerable when having more clinical evidence No Because the risk for the patient sustaining a fracture in the next 10 y is low • Adequate calcium dietary, vitamin D • Icrease weight-bearing exercise • Prevent falls • Very low or ultra-low HRT or oral bisphosphonates can be considered Yes Because the risk for a subsequent fx is high Anti-resorption (alendronate, risedronate or raloxifene) Rx?

  4. Case 3 Status Medical History • Women, 65 y • Frequent back pain • - HRT: undesired • Menaupause: 50y • Lose ht: 8cm • Prior fx (distal radius) Yes Measure BMD Further examination? Yes Maybe vertebral fracture (back pain) Spinal X-ray? • Depend • Osteoporosis: YES • Non-osteoporosis: NO Normal Rx? Anti-resorption (alendronate, risedronate or raloxifene) Rx? Vertebral fx Yes

  5. Case 4 Status Medical History • Men, 80 y • Arrival with hip fracture • (fall from standing height) • Difficult to keep balance when standing • Susceptible to fall NO Further examination? NO Apparently Clinical features Spinal X-ray? Normal Rx? Rx? Anti-resorption (alendronate, risedronate or raloxifene) Vertebral fx

  6. Case 5 Status Medical History • Never use HRT • Had asthma since childhood, current medications: b.i.d. steroid inhale+ glucocorticosteroid 5-6 times/y for 2-6 wk for exacerbations. • Diagnosed with a seizure disorder at aged 20y, currently well controlled with Phenytoin 300mg/d. • Currently use multivitamin daily • No history of osteoporotic fracture. • Surgical menopause five years previously • Women, 45 y, teacher • No height loss. • Body weight at average of age group. • Expiratory wheeze noted. • BP: 140/82 • BMD T-scores: -2.6 • Lab test results: • sCa: 8.9 (normal: 8.6-10.2) • normal CBC • normal cholesterol • 24-hour urine calcium: 50 mg • 25 OH vitaminD:8ng/mL (normal: > 20).

  7. Case 5 Comments Summary • BMD much lower than expected level for her age • Several risk factors for secondary osteoporosis: • early surgical menopause • chronic exposure to anticonvulsants • corticosteroids use • Vitamin D defficiency + seizure  high risk of fall This case is a timely reminder that not all low bone density is simple osteoporosis. Several potential causes of secondary osteoporosis needed to be addressed before she could be treated successfully for Further examination? • HRT is suitable • Bisphosphonates Rx? NO

More Related