Case 1
A 48-year-old Asian American woman is concerned about thin bones. Her mother was diagnosed
with osteoporosis at the age of 50 and fell at the age of 68 and fractured her hip and spent months
in Rehab before being able to return home. The patient has no history of fractures.
The patient presents to the office to have her bones checked to see if she has “thin bones”
Patient has no history of previous fractures: Patient states she went through Menopause at the
age of 43-44 with no major problems. Patient was diagnosed with hypothyroid at at age 40.
Patient does not drink. Smokes 1ppd for 20 yrs. Husband has been out of work for 9 months due
to downsizing at his job. Pt works as an administrative assistant for a publisher but does not have
health insurance at this time.
Pt had a melanoma removed from her left cheek in 2018; No hospitalizations except for
childbirth x2
Family history: Paternal Grandmother died at age 78 due to heart disease. Paternal Grandfather
died at age 83 due to heart attack. Maternal Grandmother died at age 82 cause unknown;
Maternal Grandfather died from farm accident at age of 56. Mother is 75 alive with Osteoporosis
diagnosed at age 50 and HTN diagnosed at age 63. Father is 77 alive with HTN diagnosed at age
45. Pt has two daughters alive and well with no medical problems.
Objective Info
Height 5’2′ Wt 105 lbs; BMI 19.2; 128/78; HR-72/min
• HEENT: Normocephalic, no lumps/lesions
• Neck: supple without adenopathy , no thyromegaly.
• Lungs: Eupneic, CTA
• CV: RRR, no murmurs, rubs or extra sounds noted; 2+ peripheral pulses, no edema noted
• Breast: soft, fibrocystic changes bilaterally, without masses, dimpling or discharge
• Abd: soft, +BS, no tenderness
• MS: Full ROM in spine and shoulders. No tenderness, no spasms
• T-Score is -1.2
Questions
1. What other information do you need
2. What other diagnostic tests would be appropriate for this pt?
3. Is this patient at high risk or low risk? What are her risk factors
4. What other screenings are appropriate for this patient?
5. What is the difference between a Z score and a T score?
6. What would you include in patient education to prevent further loss of bone? Be specific
