INSTRUCTIONS FOR THE DOCTOR
Please explain the test results to Flora and develop a management plan with her for the prevention of further osteoporotic fractures.
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:
|Scan ||BMD g/cm2 ||T-score ||Fracture risk ||Z-score ||Peer relationship |
|Lumbar spine ||0.854 ||−2.6 ||Marked ||−1.2 ||Lowest quartile |
|Total femur (L) ||0.686 ||−2.6 ||Marked ||−1.5 ||Lowest quartile |
The following information is on her medical record:
INSTRUCTIONS FOR THE PATIENT, FLORA MCMILLAN
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.)
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.
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.
The following information is on your medical records:
SUGGESTED APPROACH TO THE CASE
Check reason for attendance—to obtain results of bone density scan
— 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
Maintain/improve bone density
— 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