Osteoporosis

Shortened

Step 1: View clinicals

A 65 year old woman presents with persistent pain in her middle and lower back, which started around a month ago, after she attempted to pick up a potted plant. The pain is worsened by exertion, and relieved by lying down; it has progressively increased over time. There was no associated tingling, numbness or weakness. Her menopause was at 48 years of age. She has never been on hormone replacement therapy.


Step 2: Order all relevant investigations

X-Ray Lumbar Spine

There is a compression wedge fracture of the L1 vertebral body. The L4/L5 and L5/S1 disk spaces are narrowed.

DXA scan and VFA

The DXA scan of the spine gives a T-Score of -2.7 VFA: Grade 1 stable vertebral wedge fracture deformity of the L1 vertebral body.

ESR

The ESR is 25 mm/1h (normal: 0-30)

S. Ca++, PO4--- & ALP

S. Ca++: 9.2 mg/dl (8.9-10.1 mg/dL) S. PO4---: 3 mg/dl (2.5-4.5 mg/dL) Alkaline Phosphatase (ALP): 130 IU/L (44-147 IU/L)


Step 3: Select appropriate management

Spinal Fixation
Strict Prolonged Bed Rest
Hyperextension Braces
Bisphosphonates


Score: ★★☆