Clinical Cases
Clinical Cases
Akbar Soltani. MD.Endocrinologist
Tehran University of Medical Sciences (TUMS)
Evidence-Based Medicine Research Center
Shariati Hospital
Approach to declining BMD
Hypothetical low risk scenario
- A 69-year-old woman comes to you for evaluation of osteoporosis. She has been treated with risedronate, 3.5 mg orally once weekly with good adherence to therapy.
- She has been taking cholecalciferol, 2000 IU daily, in addition to calcium carbonate, 600 mg twice daily with meals.
- Her initial DXA scan revealed the following T scores: lumbar spine, - 1 .9, femoral neck, -2.8, and total hip -2.6
Hypothetical high risk scenario
- A 53-year-old woman comes to you for evaluation of osteoporosis. She had a hip fracture 6 months ago and multiple vertebral compression fracture and loss of height during last three years. She has been treated with risedronate, 3.5 mg orally once weekly with low adherence to therapy
- She has been taking cholecalciferol, 2000 IU daily, in addition to calcium carbonate, 600 mg twice daily with meals.
- Her initial DXA scan shortly after his fracture, revealed the following T scores: lumbar spine, - 1 .9, femoral neck, -2.8, and total hip -2.6
Scenario
BMD decreased
- At the time of her original study, her femoral bone density study was 0.960 g/cm2.
- Two years later, the femoral BMD was 0.920 g/cm2. Is this a significant change?
- % Change from Baseline = 4%
- Next intervention?
