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Review Question - QID 102744

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QID 102744 (Type "102744" in App Search)
A 61-year-old woman presents to the office for an annual exam. She has a history of polymyalgia rheumatica, hypertension, and hyperlipidemia. She takes prednisone, lisinopril, and atorvastatin. She leads a relatively sedentary lifestyle and works in an office. She has a 40 pack-year smoking history and drinks 3-4 drinks per day. She is not sure of any significant family history, but does state that her mother suffered a hip fracture at the age of 60. Her temperature is 98.6°F (37.0°C), pulse is 80/min, blood pressure is 130/90 mmHg, and respirations are 14/min. Her BMI is 34 kg/m^2. She is worried about her risk for osteoporosis and wonders if she would qualify for osteoporosis screening. Which of the following is not an indication for early osteoporosis screening in this patient?

Alcohol use

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Elevated BMI

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Sedentary lifestyle

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Smoking

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Steroid use

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This patient with a history of smoking, alcohol, and steroid use has several risk factors for osteoporosis. Her As a result, she should receive early osteoporosis screening. However, her elevated BMI is not a risk factor for osteoporosis.

Osteoporosis is common in elderly women and is a significant source of morbidity due to elevated fracture risk. Risk factors for osteoporosis in addition to age and sex include history of smoking, excessive alcohol consumption, steroid use, and low body mass index. Weigh bearing exercise in considered a protective factor, and light resistance training is recommended for most elderly women to decrease their risk for osteoporosis. This patient has several risk factors for osteoporosis. However, her elevated BMI is not a risk factor for osteoporosis. Due to her sedentary lifestyle, smoking, alcohol consumption, and steroid use, she should receive a screening DEXA scan. For women at average risk of osteoporosis, the USPSTF recommends a one time DEXA scan at the age of 65.

Yong et. al review the diagnosis and management of osteoporosis. They discuss typical risk factors to include smoking, alcohol, and steroid use. They recommend early screening for those at an elevated risk.

Illustration A depicts normal bone compared to that observed in osteoporosis. Note the porous, weakened appearance of the bone.

Incorrect Answers:
Answer 1: Alcohol use elevates the risk of osteoporosis. As a result, patients with a history of excessive alcohol use qualify for early osteoporosis screening.

Answer 3: A sedentary lifestyle elevates the risk of osteoporosis. As a result, patients with a history of a sedentary lifestyle and lack of weight bearing exercise qualify for early osteoporosis screening.

Answer 4: Smoking elevates the risk of osteoporosis. As a result, patients who smoke qualify for early osteoporosis screening.

Answer 5: Steroid use elevates the risk of osteoporosis. As a result, patients with a history of steroid use qualify for early osteoporosis screening.

Bullet Summary:
Patients with risk factors for osteoporosis qualify for early screening with DEXA scan.

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