Question

Chief Complaint: 72-year-old woman who fell on her right hip. of the right l History: Margaret Donovan, a 72-year-old white female, was brought to the emergency room son-in-law after falling in her bathtub. She was previously in good health, despite leading a rela sedentary lifestyle and having a 30-pack-year history of cigarette smoking. The only medica currently takes is Inderal (propranolol) for mild hypertension. She fell upon entering the her right leg slipped out from under her; she landed on her right hip. There was no nor does she complain of right or left wrist pain. However, she reports severe pain upper thigh, and was unable to get up after her fall. by her red into se tion she trauma to her head, n the righ t hip and hanter an hysical Examination: The patient was alert, oriented to time, place, and date, and was responding appropriately to questions despite being in considerable pain. There were no signs of trauma to the head, neck, torso, arms, or left leg. The right thigh and hip were extremely tender and were immobilized by a leg splint. Heart and lung sounds were normal, and abdominal sounds were reduced. An injection of oxymorphone hydrochloride (Numorphan) helped relieve her pain and she was taken to the radiology department for an X-ray of her right leg and hip. stics mal f Radiology Report: The X-ray of the right hip revealed a complete, comminuted, intertrochanteric fracture of the right hip. No other fractures were noted in the right leg. There were also long-term osteoporotic changes in the femur, tibia, and fibula. to

Answer 1

8. prolonged bed rest and immobilization can lead to complications. it is more easier to prevent than to   treat. the musculoskeletal complications include loss of muscle strength and endurance, contractures and soft tissue changes and degenerative joint diseases.

secondary complications lead to DVT, pulmonary embolism, pressure sores , urinary tract infections,

9. osteoporosis is caused due to the lack of calcium. low calcium intake contributes to diminished bone density and early bone loss

Risk factors

- include age , sex , lifestyle ,medical conditions and treatments

- age : older age

- sex : women are more prone to get osteoporosis than men

- hormonelevels : lowe sex hormone tend to weaken bone . the reduction of oestrogen levels in females at menopause is one of the strongest risk

   thyroid problems

- dietry factors : low calcium intake , eating disorders,

- medications : long term use of steroids and other medications

- sedentary lifestyle

- excessive alcohol consumption

- tobacco use

Indications of bone density measurement

- women aged above 65 and older

- postmenopausal women under age 65 with risk factors of fracture

- men aged 70 and older

- men under age 70 with clinical risk factor for fracture

- women during menopausal transiction with clinical risk factors for fracture, low body weight, high risk medication use

- adults with fragility fracture

- adults with diseases associated with low bone mass ore bone loss

- adults taking medications associated with low bone mass

- anyone considering pharmacological therapy

- anyone being treated to monitor treatment effect