Answer The Following Items Using Your Own Words Be Objective
Answer The Following Items Using Your Own Words Be Objective And Conc
1. During a case presentation at your clinic, you review four women with predisposing factors for osteoporosis. Which patient is least likely to be at risk for osteoporosis?
A. Nehineza, an overweight African American female with a family history of uterine cancer
B. Cristina, a Hispanic woman living a sedentary life
C. Park-Gim-Ka, an underweight Asian woman with a history of tobacco use
D. Skylar, a Caucasian woman experiencing early onset of menopause.
Among these women, Nehineza is the least likely to be at risk for osteoporosis. Although she has a family history of uterine cancer, her being overweight, especially within the African American demographic, confers a protective effect against osteoporosis due to increased mechanical loading on bones and higher bone mineral density (BMD). In contrast, Cristina's sedentary lifestyle, Park-Gim-Ka's underweight status combined with tobacco use, and Skylar's early menopause significantly elevate their osteoporosis risk. Early menopause accelerates bone loss due to decreased estrogen, which plays a vital role in maintaining bone density. Similarly, low body weight and tobacco use negatively impact bone health, increasing susceptibility to osteoporosis (Compston et al., 2019).
2. Densitometry results are given as T-scores. Which values would be considered osteopenia?
Osteopenia is characterized by T-scores that are lower than normal but not yet in the osteoporosis range. According to the World Health Organization (WHO), T-scores between -1.0 and -2.5 standard deviations from the young adult mean are indicative of osteopenia. Specifically, a T-score of -1.0 to -2.5 signifies reduced bone density that increases fracture risk but does not meet the criteria for osteoporosis. T-scores above -1.0 are considered normal, so values within the -1.0 to -2.5 range indicate osteopenia (Kanis et al., 2019).
3. After prompt analysis of your patient, you decide to institute treatment for osteoporosis. Which class of medication is considered the first-line treatment? Are there any considerations to be made prior to starting therapy? Which recommendations would you provide to the patient regarding this treatment?
The first-line treatment for osteoporosis typically involves the use of bisphosphonates, which are effective in reducing fracture risk by inhibiting osteoclast-mediated bone resorption. Common agents include alendronate, risedronate, and zoledronic acid. Prior to initiating bisphosphonate therapy, it is essential to evaluate the patient's renal function, as these medications are contraindicated in severe renal impairment. Additionally, patients should be assessed for gastrointestinal issues, as oral bisphosphonates can cause esophageal irritation, and they should be counseled on proper administration—taking the medication with a full glass of water on an empty stomach, remaining upright for at least 30 minutes to prevent esophageal damage.
Patients should also be advised to ensure adequate intake of calcium and vitamin D to support bone health. Lifestyle modifications such as engaging in weight-bearing exercises, quitting smoking, and limiting alcohol intake are recommended to complement pharmacologic treatment. It is crucial to monitor for potential adverse effects, including osteonecrosis of the jaw and atypical femoral fractures, although these are rare. Regular follow-up with bone density testing should be scheduled to assess treatment efficacy and adherence (Cummings et al., 2018; Black et al., 2020).
References
- Black, D. M., Rosen, C. J., & Schneider, D. (2020). Osteoporosis. Harrison's Principles of Internal Medicine, 20th Edition.
- Compston, J., McClung, M., & Leslie, W. D. (2019). Osteoporosis. Lancet, 393(10169), 364–376.
- Cummings, S. R., et al. (2018). Endsosteoporosis treatment: efficacy and safety of bisphosphonates. New England Journal of Medicine, 378(20), 1935–1945.
- Kanis, J. A., et al. (2019). European Guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis International, 30(1), 3–44.