Your patient is an overweight 75 years old female with no history of bone fracture. She has never had a bone mineral density test and asks if she should have one. You are unaware of any risk factors in her other than her postmenopausal status.
1. What will you tell this patient?
2. Which Of the Medications can increase her risk for osteoporosis?
1. What will you tell this patient?
Answer: Bone densitometry screening is currently recommended for all women age 65 years and older.
Case Discussion:
Risk Factors For Osteoporosis: The National Osteoporosis Foundation recommends bone densitometry for postmenopausal females with one or more of the following risk factors:
- family history of osteoporosis,
- personal history of low trauma fracture,
- current smoking, or
- low body weight (<127 lbs.).
- female sex,
- Caucasian or Asian races,
- alcohol abuse
- sedentary lifestyle, and
- poor intake or absorption of calcium and vitamin D.
- Smoking
Diabetes, once thought to protect against osteoporosis, may actually increase the risk of falls and
fractures in older adults.
The preferred method for measuring bone density is dual-energy radiographic absorptiometry (DEXA).
All postmenopausal women should consume 1200 mg of elemental calcium per day in divided doses. The optimal amount of vitamin D is 400–800 IU/day. Weight-bearing exercises also strengthen bone. Bisphosphonates are indicated for treatment of osteoporosis and should not be used without a diagnosis
Role Of Vitamin D Supplements: Supplementing vitamin D is probably more important than supplementing calcium. Calcium supplementation has not consistently demonstrated fracture risk reduction. However, many elderly people are vitamin D deficient, and correction of the deficiency results in reduced fracture risk. Given the low risk of adverse effects with daily vitamin D (up to 1000 IU/day), empiric supplementation
is justifiable. Finally, 1000 mg (not 1500 mg) of calcium is probably plenty. Additional calcium
has been linked to an elevated risk of Coronary artery disease or MI and no change in fracture risk. Calcium and vitamin D are clearly beneficial in those with osteoporosis, however.
2. Which Of the Medications can increase her risk for osteoporosis?
Answer: Glucocorticoids and anticonvulsants are known to increase bone turnover, resulting in increased risk of osteoporosis. Loop diuretics cause renal calcium wasting. There is an association between proton-pump inhibitor use and osteoporosis, possibly through reduced calcium absorption or direct effects on bone metabolism. Additionally, heparin, methotrexate, cyclosporin, and gonadotropin-releasing hormone agonists may increase the risk of osteoporosis. Excessive
amounts of levothyroxine can cause increased bone turnover.
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