Endocrinology Question 29 Instructor

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

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