Osteoporosis Risk Assessment and Management

by | Jul 13, 2024 | Nursing

 

Case1

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 age45. Pt has two daughters alive and well with no medical problems.
Objective Info
Height 52 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.

 

Sample Answer

Sample Answer

 

Case Analysis: Osteoporosis Risk Assessment and Management

Patient Profile

– Age: 48-year-old Asian American woman
– Medical History: Hypothyroidism at age 40, menopause at 43-44, no history of fractures
– Family History: Mother diagnosed with osteoporosis at 50, paternal grandmother died of heart disease, maternal grandparents’ causes of death, daughters with no medical problems
– Social History: Non-drinker, smoker (1 pack per day for 20 years), husband unemployed for 9 months, administrative assistant without health insurance
– Objective Info: BMI 19.2, blood pressure 128/78, T-Score -1.2

Questions Analysis

1. Additional Information Needed:

– Menstrual history to assess estrogen exposure, detailed smoking history, dietary habits (calcium and vitamin D intake), physical activity level, current medications, vitamin/mineral supplements.

2. Appropriate Diagnostic Tests:

– Dual-energy X-ray absorptiometry (DXA) scan for bone mineral density measurement, thyroid function tests to monitor hypothyroidism management, vitamin D levels, complete blood count (CBC), comprehensive metabolic panel.

3. Risk Assessment:

– The patient is at moderate risk due to family history, early menopause, hypothyroidism, smoking history, low BMI, and lack of health insurance. Risk factors include genetics (family history of osteoporosis), hormonal factors (early menopause), lifestyle choices (smoking), and socioeconomic factors (lack of health insurance).

4. Appropriate Screenings:

– Regular bone density screenings (DXA scan), annual thyroid function tests, cardiovascular risk assessments due to family history of heart disease, skin cancer screenings due to melanoma history.

5. Difference between Z Score and T Score:

– T-Score: Compares an individual’s bone density to that of a healthy young adult of the same gender. A T-score of -1 to -2.5 indicates osteopenia, while below -2.5 indicates osteoporosis.
– Z-Score: Compares an individual’s bone density to that of age-matched peers of the same gender and ethnicity. It helps assess bone density in younger individuals or those with conditions affecting bone health.

6. Patient Education on Bone Health:

– Diet: Encourage calcium-rich foods (dairy products, leafy greens) and vitamin D sources (fatty fish, fortified foods).
– Physical Activity: Promote weight-bearing exercises (walking, dancing) and strength training to improve bone strength.
– Smoking Cessation: Provide resources and support for quitting smoking to reduce fracture risk.
– Fall Prevention: Educate on home safety measures, balance exercises, and regular vision check-ups to prevent falls and fractures.

Conclusion

Assessing the patient’s osteoporosis risk factors and implementing appropriate diagnostic tests and screenings are essential for early detection and intervention. By addressing modifiable risk factors through patient education and lifestyle modifications, healthcare providers can mitigate the risk of further bone loss and improve the patient’s overall bone health outcomes. Regular monitoring and preventive measures play a crucial role in managing osteoporosis effectively and enhancing the patient’s quality of life.

 

 

 

This question has been answered.

Get Answer