Liz B. is a 73-year-old white woman who is seeing her doctor for a regular physi

Question

Liz B. is a 73-year-old white woman who is seeing her doctor for a regular physical. She is married and retired, but volunteers for several organizations and watches her grandchildren two mornings a week. She and her husband play golf about once a week during the spring, summer, and fall. She weighs 130 pounds and always thought she was 5’6”. However, when she was measured at this physical, she was 5’4”. Because of her age and height loss, she has a dual-energy x-ray absorptiometry (DEXA) measurement that shows that she has low bone mineral density (BMD) values of her proximal femur and lumbar vertebrae (both values are classified as osteoporotic according to World Health Organization definitions). A chest x-ray also revealed two vertebral fractures. However, she has no pain in her back or neck. The RDN and Liz discuss her diet, concluding that her diet is low in calcium and vitamin D, but high in sodium. Along with suggestions to decrease her sodium intake and increase her fruit and vegetable intake, she is advised to start taking supplements of calcium (1000 mg/day) and vitamin D (800 units/day). They discuss avoiding high-impact exercise affecting the spine because of the low bone mass and existing vertebral fractures, but increasing flexibility, balance, and posture exercises. Because of the DXA results, she also begins on a bisphosphonate drug in addition to the calcium and vitamin D supplements. She receives baseline tests of bone turnover, to be rechecked in 6 months and an appointment for another DXA in 1 year. After 1 year on the medication, supplements, diet and exercise changes, Liz has another DXA. Her BMD has improved to the osteopenia level, and she is taken off the bisphosphonate medication.

5 - What risk factors does Liz have for developing osteoporosis? Be specific. (3)

6 - What medications will increase risk for osteoporosis? Use textbook reference pages (3)

7 - What two hormones regulate calcium concentration? (2)

8 - When did L iz reach her peak bone mass? (1)

9 - In talking with Liz, you outline foods that interfere with calcium absorption, what are they? (2)

10 - What are the National Osteoporosis Foundation’s universal guidelines for all adults for the prevention of osteoporosis? (4)   

Explanation / Answer

5. The risk factors are age, gender and bone structure and body weight.

When age is advancing the risk for getting osteoporosis increases, she is 73 year old and it increase the risk. Women are at greater risk as compared to men and thin women are at risk because she has less bone to lose as compared to fatty women.

6. Glucocorticoids, also called steroids, such as cortisone and prednisone,

Some medicines such as phenytoin and phenobarbital, used to treat epilepsy,

Gonadotropin-releasing hormone agonists such as goserelin acetate and leuprolide acetate increase risk for osteoporosis.

7. The hormones calcitriol, calcitonin regulate calcium concentration in our body.

8. After 1 year on the medication she reached her peak bone mass

9. Foods that contain oxalates and phytates block calcium absorption.oxalate containing foods are rhubarb, beets, okra, spinach, Swiss chard,sweet potatoes, tea, chocolate, and soy products. Foods rich in phytates include fiber-containing whole-grain products and wheat bran, beans, seeds, nuts, and soy isolates.

10. National Osteoporosis Foundation’s advices guidelines for all adults for the prevention of osteoporosis are adequate intake of calcium and vitamin D , regular exercise,avoid use of alcohol and tobacco and prevention of fall.

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