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Reduced physical activity to decrease the chance of a fall
0%
0/16
Initiating a swimming exercise program three days per week
56%
9/16
Intranasal calcitonin therapy
Calcium and vitamin D supplementation
38%
6/16
Weight loss
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This patient with a DEXA T-score of less than -2.5 has osteoporosis. Interventions that decrease the risk of osteoporosis include: smoking cessation, a weight-bearing exercise regimen, vitamin D and calcium supplementation, or hormone replacement therapy. Primary osteoporosis (post-menopausal or senile types) is a reduction in bone mass and bone density due to increased osteoclastic bone resorption and decreased bone formation by osteoblasts in the absence of another disease process. It is most commonly seen in thin, postmenopausal, Caucasian or Asian women. Additional risk factors include smoking, caffeine and alcohol intake, family history, low calcium/vitamin D intake, and nulliparity. Jeremiah et al. discuss the screening for and workup of osteoporosis. The USPSTF recommends DEXA scans for all women age 65 and older as well as younger women determined to have an increased fracture risk. In new osteoporosis diagnoses, secondary causes should be ruled out by assessing laboratory values of vitamin D, calcium, creatinine, and TSH. Reid et al. review the benefits and risks of calcium supplementation. The authors argue that calcium supplementation has a negative risk-benefit ratio, with risks including gastrointestinal side effects, kidney stones, and increased myocardial infarction risk. In addition, many large meta-analyses have failed to demonstrate a significant reduction in fracture risk as a result of calcium supplementation. Illustration A shows a classification of osteoporosis based on DEXA scan T-score. Incorrect Answers: Answer 1: Although fall-precautions are important in preventing a fracture in any elderly person, weight-bearing exercises such as vigorous walking and/or weightlifting increase bone stress, which reduces the risk of osteoporosis. Answer 2: Swimming, although beneficial from a cardiovascular standpoint, reduces bone stress and does not prevent development and/or progression of osteoporosis. Answer 3: Intranasal calcitonin therapy is a last-line treatment option for osteoporosis; bisphosphonates and preventative measures should be attempted first. Answer 5: Weight loss, particularly greater than 10% of body weight, increases the risk of bone loss and osteoporosis.
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