Osteoporosis, Secondary

Broken 2

Step 1: View clinicals

A 45-year-old woman presents with dull back pain, which started suddenly three days ago, and has since worsened. The pain is exacerbated by movement. There is no history of trauma or lifting heavy weights. She was diagnosed with moderate persistent asthma around 10 years ago and prescribed inhaled salmeterol and fluticasone. However, she has shown poor compliance and has experienced frequent exacerbations, which were often treated with oral prednisolone. She is physically active and does not smoke or consume alcohol. She continues to have regular menstrual cycles. Her family history is unremarkable. Spinal x-rays reveal a compression fracture of the second lumbar vertebra, while the entire spine appears mildly osteopenic. A complete blood count, liver profile, renal profile, HbA1c, ESR, and CRP are all found to be normal.


Step 2: Order all relevant investigations

Dual energy X-ray absorptiometry

Dual energy X-ray absorptiometry (DXA) of the lumbar spine and femoral neck yields Z-scores of -2.9 and -2.1 respectively.

25-OH vitamin D levels

Serum 25-OH vitamin D level: 38 ng/mL (20-50)

Serum Calcium + Phosphorus

Ca++: 9.1 mg/dL (8.5-10.2) PO4--: 3.0 mg/dL (2.5-4.5)

Iliac crest bone biopsy

You realize that a biopsy is not indicated in this patient.


Step 3: Select appropriate management

Urgent Vertebroplasty
Bisphosphonates
NSAIDs
Denosumab


Score: ★★☆