Musculoskeletal Problems.
Case Study: Osteoporosis
Mrs. Pelletier is a 75-year-old female who presents to the health care provider’s office for back pain. She has a history of hypertension, Crohn’s disease, and hypothyroidism. She is currently taking the following medications:
Metoprolol 50 mg PO twice daily
Sulfasalazine 500 mg PO twice daily
Prednisolone 5 mg PO twice daily
Levothyroxine 75 mcg PO daily,/li>
Subjective Data
Has had some mid-back pain for the past week, which is worse when standing or walking and is relieved a little by lying down
Her back pain at the moment is a level 4, on a 1 to 10 scale
Denies any recent injury to her back
Broke her wrist a few months ago, but doesn’t know how
Her Crohn’s disease just ‘flared up’ a couple of weeks ago
Lactose intolerant
Objective Data
Temperature 98.2° F, pulse 74, respirations 16, blood pressure 130/78
Height 5 feet 3 inches, Weight 100 lb, BMI 17.7 kg/m2
Kyphosis of the spine
Question 1
The health care provider suspects Mrs. Pelletier has osteoporosis. What are her risk factors for osteoporosis?
Mrs. Pelletier’s risk factors for developing osteoporosis are her gender (female), age (>65 yr), low body weight, Crohn’s disease (due to malabsorption problems), nontraumatic fracture of her wrist, and use of corticosteroids for her Crohn’s disease and levothyroxine for her hypothyroidism.
Rationale
No rationale provided.
Question 2
What studies could be done to support the diagnosis of osteoporosis?
Bone mineral density (BMD) measurements are typically used to assess the mass of bone or how tightly the bone is packed. Types of BMD studies include quantitative ultrasound (QUS) and dual-energy x-ray absorptiometry (DEXA).
Rationale
No rationale provided.
Question 3
Mrs. Pelletier’s diagnostic testing yielded a bone density T-score of -3. What does this mean?
A T-score of -3 means that Mrs. Pelletier’s BMD is 3 standard deviations below the mean BMD of young adult. Any score greater than 2.5 standard deviations is defined as osteoporosis.
Rationale
No rationale provided.
Question 4
Mrs. Pelletier is prescribed alendronate. What instructions should Mrs. Pelletier receive regarding taking this medication?
There are gastrointestinal side effects associated with taking bisphosphonates such as alendronate including dyspepsia, abdominal pain, and the most common one, esophageal irritation or esophagitis. To decrease these side effects, teach Mrs. Pelletier to take her alendronate with a full glass of plain water 30 minutes before food or other medications, and to remain upright for at least 30 minutes after taking it.
Rationale
No rationale provided.
Question 5
What nutritional teaching is important for Mrs. Pelletier with her new diagnosis of osteoporosis?
Treatment of osteoporosis focuses on adequate calcium intake. Teach Mrs. Pelletier to take calcium 1500 mg/day. Due to Mrs. Pelletier’s lactose intolerance, she is not able to consume dairy products to get her daily calcium intake. Foods that are high in calcium that do not have lactose include almonds, sardines, salmon, turnip greens, and spinach. Supplemental calcium is likely if dietary intake of calcium is inadequate. Vitamin D is also necessary for calcium absorption and function and may have a role in bone formation. The recommended dosage for postmenopausal women is 800-1000 IU/day.
Rationale
No rationale provided.
Question 6
What other teaching is appropriate for Mrs. Pelletier?