Question

MERAERI DIRILIS CASE STUDY Case Study: Episode 1 Eileen Doherty is a 55-year-old female patient who presents to her health care provider with complaints of increasing difficulty in walking, increasing pain in her lower back and showing early signs of kyphosis in her posture. She is currently on no medications and states she takes a multivitamin and calcium "when she remembers them." Eileen has annual checkups with her health-care provider, and despite her relatively good health, she is concemed about the recent pain and resulting limitations on her activity level. Case Study: Episode 2 Eileen Doherty has returned to her health-care provider with complaints of increasing pain in her lower back and the "feeling like I could fall" while walking. Her kyphotic posture appears to be worsening, and while her height is measured, it is noted that she has a decrease from 5 ft 3 in to 5 ft 2.5 in over the course of the year. She remains on her medication regimen of multivitamins and calcium and states she has begun to take Aleve (naproxen) for pain. She is very concerned about her fear of falling, increasing level of pain, and decreasing level of function. Case Study: Wrap-up Ms. Eileen Doherty demonstrates classic signs of osteoporosis (vertebral changes noted as kyphosis, or "dowager's hump"). She states she has noticed that her pants seem longer. She complains of back pain and increased difficulty with simple activities of daily living such as short 00

Answer 1

1. a- idont need to take calcium and vit D anymore-

elderly patients with osteoporosis requires suplements with calcium and vit d since there is a lack of both in the body which leads to deformitites and joint disorders.

2.a.FRAX-

To help determine your risk for such an injury, doctors developed the Fracture Risk Assessment Tool (FRAX). Your FRAX score is your risk of having an osteoporosis-related fracture in the next 10 years.

The formula for measuring your risk uses factors such as:

• age
• weight
• gender
• smoking history
• alcohol use
• fracture history

3.low BMD.-

Bone mineral density (BMD) decline is a major reason for the increased risk of fractures. Many epidemiological studies have indicated that BMD values tend to decrease as people get older. Dual-energy X-ray absorptiometry (DXA) is the standard and most precise technique for BMD measurement and BMD is the standard measure for diagnosis of osteoporosis.

4.a.bonivia is taken on a empty stomach-

Tablets should be taken at least 60 minutes before the first food or drink of the day (other than plain water) or before other oral medication, because of concern that that food or medication will interfere with the absorption of ibandronate. Absorption of ibandronate from the intestine is poor, and any potential further decrease in absorption by food or medications needs to be avoided.Ibandronate tablets also should be swallowed whole with six to eight ounces of plain water while in an upright position, in order to be certain that the tablets enter the stomach. If the tablets stick in the esophagus they can irritate the esophagus. For the same reason, patients should not lie down for 60 minutes after taking ibandronate since tablets are more likely to stick in the esophagus when lying down

5.b.decresase in estrogen level.-

Estrogen deficiency can lead to excessive bone resorption accompanied by inadequate bone formation. Osteoblasts, osteocytes, and osteoclasts all express estrogen receptors. In addition, estrogen affects bones indirectly through cytokines and local growth factors. The estrogen-replete state may enhance osteoclast apoptosis via increased production of transforming growth factor (TGF)–beta.