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Course Sample:
Introduction Case Study: Teri is 42 years old. She came to see her primary care provider for the management of new onset depression and insomnia. During the health history, she reveals that her mother is alive and in good health but takes medication for osteoporosis. Teri is a runner, with several local road races under her belt. She takes care to watch her diet and takes a daily multivitamin with calcium. She is a registered nurse, married, and a mother of 5 children, ranging in age from 3 to 15. She is currently on no medications, has a negative surgical history, and has no drug allergies. Examination reveals a very small framed Caucasian woman weighing 102 pounds but who looks well nourished. Her vital signs are normal. Her skin has no lesions. She has no complaints of muscle or joint aches. Heart and lung auscultation are normal as is her thyroid palpation. Her breast and pelvic exam are also unremarkable. Laboratory studies include a complete blood count, comprehensive metabolic panel including labs such as a fasting glucose, sodium, potassium, Co2, alkaline phosphatase, BUN, creatinine, and thyroid stimulating hormone. All lab results are normal. Teri is diagnosed with depression and after an office visit and review of the labs an appropriate antidepressant is prescribed with instructions to recheck in three to four weeks. At her recheck, she indicates she is doing fine and she is advised to return next year for her annual exam. What was missed? Teri has osteoporosis. The clinician should be alerted by her small frame, Caucasian status, and family history of osteoporosis. Many clinicians are very aware that menopausal women are at risk, but who else should we be watching? It is important for providers to know that other patient populations are also at risk for osteoporosis. Knowing who is at risk, as well as knowing what appropriate screening measures are available is imperative in diagnosing this condition. Knowledge of the current treatments, lifestyle changes as well as pharmacologic measures, is equally important. Who is at risk? The following are risk factors for bone loss: · Females · Current or past history of hyperparathyroidism (with or without treatment) · Women with an absence of menstrual periods (such as athletes) · Anorexia · Advancing age · |
