Osteoporosis
MKSAP
Overview
Osteoporosis
Risk Factors
WHO Classification
National Osteoporosis Treatment Guidelines
Pharmacotherapy
Nutrition!!
Calcium and Fractures
MKSAP
References

MKSAP
A 72-year-old man is evaluated for a two-week history of low back pain. The patient has a history of alcoholism but stopped drinking alcohol 10 years ago. He also has stage 3 chronic kidney disease and a 50-pack-year smoking history. Current medications are hydrochlorothiazide, ramipril, and a multivitamin.
On physical examination, vital signs are normal. Lumbar lordosis, decreased mobility and spasm of the paravertebral muscles, and tenderness to palpation at L4-L5 are noted. Neurologic screening examination findings are normal.
Laboratory studies show calcium 9.0 mg/dL (2.25 mmol/L), creatinine 2.1 mg/dL (185.6 µmol/L), phosphorus, 3.2 mg/dL (1.0 mmol/L), parathyroid hormone 50 pg/mL (50 ng/L), testosterone 400 ng/dL (13.9 nmol/L), 25-Hydroxy vitamin D 34 ng/mL (85 nmol/L), and estimated glomerular filtration rate 40 mL/min/1.73 m2.
A radiograph of the lumbosacral spine shows a compression fracture of L4. A dual-energy x-ray absorptiometry scan shows a T-score of −3.0 in the lumbosacral spine and −3.2 in the left hip.