(Solved): Osteoporosis M.S., a 74-year-old woman, comes to your clinic for a complete physical examination. S ...

Osteoporosis M.S., a 74-year-old woman, comes to your clinic for a complete physical examination. She has not been to a provider for 11 years because "I don't like doctors." Her only complaint today is "pain in my upper back." She describes the pain as sharp and knifelike. The pain began approximately 3 weeks ago when she was getting out of bed in the morning and hasn't changed at all. M.S. rates her pain as 6 on a 0 - to 10 -point pain scale and says the pain decreases to 3 or 4 after taking "a couple of ibuprofen." She denies recent falls or trauma. M.S. admits she needs to quit smoking and start exercising but states, "I don't have the energy to exercise and, besides, I've always been thin." She has smoked one to two packs of cigarettes per day since she was 17 years old. Her last blood work was 11 years ago, and she cannot remember the results. She went through menopause at the age of 47 and has never taken hormone replacement therapy. The physical examination findings are unremarkable other than moderate tenderness to deep palpation over the spinous process at T7. There are no masses or tenderness to the tissue surrounding the tender spot. No visible masses, skin changes, or erythema are noted. Her neurologic findings are intact, and no muscle wasting is noted. 1. An x-ray examination of the thoracic spine reveals a collapsed vertebra at T7 and bone density changes in the spine. What could this result indicate? 2. The physician suspects osteoporosis. List 7 risk factors associated with osteoporosis 4 3. Place a star or asterisk next to those risk factors specific to M.S. Case study progress M.S. has never had an osteoporosis screening. She confides that her mother and grandmother were diagnosed with osteoporosis when they were in their early 50 s. 4. What diagnostic test is most commonly used to diagnose osteoporosis? 5. M.S.'s diagnostic test revealed a bone density T-score of \( -2.7 \). How will this be interpreted? 5. M.S. receives a prescription for alendronate (Fosamax) \( 70 \mathrm{mg} / \mathrm{wk} \). Which instructions are ppropriate as you provide patient teaching to M.S. about this drug? Select all that apply. "You can eat your breakfast along with this medication." "Take the medication with 8 ounces \( (236 \mathrm{~mL}) \) of water immediately on arising." c. "You can take this medication with your moming coffee or orange juice." d. "You need to sit or stand upright for at least 30 minutes after taking the medication." e. "If you experience any severe abdominal pain, vomiting, or jaw pain, notify your doctor immediately." 7. M.S. asks whether she needs to take a calcium supplement. How do you answer her? Case study progress M.S. asks you about foods that contain calcium. "I'd rather eat than take all these pills," she states. You review food sources of calcium with her. 8. Which foods are considered good sources of dietary calcium? Select all that apply. a. Banana b. Chicken salad c. 8 ounces ( 226 grams) of yogurt d. 1 cup ( \( 236 \mathrm{~mL}) \) of cooked spinach c. Baked potato with margarine Case study progress After reviewing her new prescription, you continue your teaching session about osteoporosis with M.S. 9. What non-pharmacologic interventions will you teach M.S. to prevent further bone loss? 10. M.S. begins to cry and says. "I cannot possibly stop smoking, change my diet, and exercise all at the same time." You encourage M.S. to start working on one problem at a time. How should it be decided which problem M.S. should attempt first? One month later, M.S. comes in to the clinic and tells you that she stopped the Fosamax a week ago because it upset her stomach too much. The physician decides to start her on denosumab (Prolia), but asks M.S. to see her dentist first. 11. M.S. asks you why she needs to see a dentist before starting the new drug. Which problem may occur during therapy with denosumab? a. Gingivitis b. Tooth loss c. Tooth decay (cavities) d. Osteonecrosis of the jaw