MKSAP: 54-year-old woman asking advice about bone health
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 54-year-old woman comes to the office for advice regarding maintaining bone health. She has no history of fracture. The patient recently had a lumpectomy and radiation therapy to treat breast cancer, is currently taking tamoxifen, and will begin taking an aromatase inhibitor in 2 months. She underwent menopause at age 52 years and has persistent hot flushes. Her risk factors for osteoporosis include a slim body habitus and a mother who had a hip fracture at age 67 years.
Physical examination findings, including vital signs, are normal. BMI is 20. Results of routine laboratory studies are normal.
A dual-energy x-ray absorptiometry scan shows T-scores of −2.1 in the lumbar spine, −2.3 in the femoral neck, and −1.9 in the total hip. Her Fracture Risk Assessment Tool (FRAX) score indicates a 22% risk of major osteoporotic fracture and a 2.4% risk of hip fracture over the next 10 years. Optimal calcium and vitamin D supplementation is recommended, and she is encouraged to begin weight-bearing exercise as tolerated.
Which of the following pharmacologic agents can be started in this patient?
A: Alendronate
B: Denosumab
C: Estrogen
D: Raloxifene
E: Teriparatide
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Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: mksap Tags: Conditions Endocrinology Source Type: blogs
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