Anita Chen is 62 year-old woman who is worried about her risk of an osteoporotic fracture. List the 8 items you would need to ask on history to assess this risk (risk of low BMD, fall, fracture).
- Prior fragility fracture + family history of hip fracture
- Currently smoking
- Currently drinking >= 3 EtOH/day
- Steroid use
- Rheumatoid arthritis diagnosis
- Falls in last 12 months
- Gait/balance problems
List the 3 items you would look for on physical examination for evidence of prior vertebral fracture.
- Loss of height: >2 cm (6 cm historical)
- Inability to put 3 or more fingers between ribs and pelvis
- >5 cm occiput-wall distance
List 2 other physical exam findings you should look for.
- Weight (>10% loss since age 25 y.o. is a risk factor)
- “Get up and go”: ability to rise from a chair with arms crossed in front of them, walk a few steps, turn around, and sit down again
List the 8 minimum lab tests you should order.
- CBC
- creatinine
- ALP
- Protein electrophoresis (if history of vertebral fracture)
- TSH
- Calcium corrected for albumin
- 25(OH) Vitamin D after 3-4 months of adequate replacement
