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INSTRUCTIONS FOR THE DOCTOR
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Please explain the test results to Flora and develop a management plan with her for the prevention of further osteoporotic fractures.
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Scenario
In January of this year Flora McMillan, aged 73, fell on her left arm and sustained a Colles fracture. She recently had a bone densitometry scan done and the results are:
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The following information is on her medical record:
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INSTRUCTIONS FOR THE PATIENT, FLORA MCMILLAN
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You are a 73-year-old teacher. You work part-time in the school library. In January of this year, you tripped over while on a walking holiday and broke your left wrist. (You did not quite hear the name of the fracture—it sounded like a Collie fracture but you though Collies were dogs.)
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You are now back at work. Your wrist is apparently healed but it feels stiff in the morning and aches after a long day of carrying books.
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Your GP arranged a bone density scan. You are here to find out the results and want to hear about anything you can do to prevent further fractures.
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The following information is on your medical records:
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SUGGESTED APPROACH TO THE CASE
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Check reason for attendance—to obtain results of bone density scan
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— Explain results in terms that Flora understands—scan demonstrates osteoporosis (‘thinning of the bones’)
— Link osteoporosis with recent fracture
— Explain risk of further fractures and need to prevent
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Maintain/improve bone density
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— Calcium intake—recommended 1000–1500 mg calcium per day, ideally through low-fat dietary sources; may need supplement if unable to meet requirements in diet
— Vitamin D—assess sun exposure, check and replace Vitamin D if at risk
— Weight-bearing exercise 30–60 minutes, three to four days per week
— Initiate treatment with anti-osteoporosis medication, e.g. bisphosphonate or denosumab
— Avoid excess alcohol and caffeine. Don’t start smoking
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