Replies to the article posted by a peer (MARCOS CAST) 1. During case presentatio

Replies to the article posted by a peer (MARCOS CAST)
1. During case presentation at your clinic, you are reviewing 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 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.
Which patient is least likely to be at risk for osteoporosis?
Osteoporosis causes bones to become weak and brittle. A number of factors can increase the likelihood to develop osteoporosis, including age, race, lifestyle choices, and medical conditions and treatments. In this group of women, I think that Nehineza, the African-American is least likely to be at risk for osteoporosis. A woman is at greatest risk of osteoporosis if is white or Asian descent and has a sedentary style of life.
2. Densitometry results are given as T-scores, which values would be considered as osteopenia?
Densitometry results are given as T-scores, which values would be considered as osteopenia?
The World Health Organization has established the following classification system for bone density:
T-score is –1 or greater: bone density is considered normal.
T-score is between –1 and –2.5: means low bone density, known as osteopenia, but not osteoporosis.
T-score is –2.5 or less: means osteoporosis.
3. After prompt analysis of your patient, you decide to institute treatment for osteoporosis. Which class medication is considered as the first-line treatment? Are there any considerations to be taken prior starting therapy? Which recommendations would you provide to the patient regarding this treatment?
Which class medication is considered as the first-line treatment?
The most widely prescribed osteoporosis medications are bisphosphonates. Examples include:
· Alendronate (Binosto, Fosamax)
· Ibandronate (Boniva)
· Risedronate (Actonel, Atelvia)
· Zoledronic acid (Reclast, Zometa)
Are there any considerations to be taken prior starting therapy?
There are some considerations to keep in mind prior taking Bisphosphonates. If are present the patient should avid this medications:
• Are allergic to them
• Have disorders of the esophagus, GERD, inflamation, erosions, narrowing, or difficulty swallowing
• Have severe kidney disease
• Can’t sit in an upright position for at least 30 minutes
• Have low levels of calcium in the bloodstream
Which recommendations would you provide to the patient regarding this treatment?
To avoid irritation to the stomach and esophagus, the patient must remain in an upright position for at least 30 minutes after taking a bisphosphonate by mouth.
References:
Leslie L. Chang, M.D., Richard Eastell, M.D., and Paul D. Miller, M.D., H.D.Sc. Continuation of Bisphosphonate Therapy for Osteoporosis beyond 5 Years. N Engl J Med, April 2022; 386:1467-1469 DOI: 10.1056/NEJMclde2115900