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Clinical Crossroads |

A 73-Year-Old Woman With Osteoporosis

Susan L. Greenspan, MD
JAMA. 1999;281(16):1531-1540. doi:10.1001/jama.281.16.1531.
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DR DALEY: Mrs Z is a 73-year-old married grandmother who lives in a suburb of Boston, Mass, with her husband. She works 4 days per week in her daughter's retail business. Her gynecologist recently referred her for evaluation of "thin bones." Mrs Z has medical insurance through Medicare and supplemental insurance.

Mrs Z underwent menarche at age 11 years and had normal menstrual periods until menopause at age 50 years. She had 2 uncomplicated pregnancies and took oral contraceptives for many years. After menopause, she took hormone replacement therapy (HRT) for only 3 years, then stopped because of fear of developing breast cancer. She smoked for 1 year in her teens and quit; she does not drink alcohol. She has never taken glucocorticoids, anticonvulsants, or thyroid medication. Her mother fractured her hip twice. There is no family history of breast cancer. The patient's daily dietary calcium intake is low, about 300 mg/d, but she has taken supplemental calcium tablets of about 1200 mg/d for the past several years. She has never had a kidney stone.

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Figures

Figure 1. Bone Mineral Densitometry of the Right Hip of Mrs Z
Graphic Jump Location
Figure 1. Mrs Z has a total hip bone mineral density (BMD) of 0.330 g/cm2 (black circle on the reference database graph) as measured by dual-energy x-ray absorptiometry, a femoral neck T score of−4.69 and a total hip T score of−5.02. The reference database graph displays age- and sex-matched mean BMD levels±2 SDs (shaded areas) derived from the third National Health and Nutrition Examination Survey.61 T score indicates the difference in SD between the subject's BMD and the predicted sex-matched mean peak young adult BMD; Z score, the difference in SD between the subject's BMD and the sex- and age-matched mean BMD; and % of mean, the subject's BMD as a percentage of the mean peak young adult BMD- or age-matched BMD level. Adapted from bone densitometry report, QDR-4500C bone densitometer, Hologic Inc, Waltham, Mass.
Figure 2. Bone Mineral Densitometry of the Lumbar Spine of Mrs Z
Graphic Jump Location
Figure 2. Mrs Z has a lumbar spine (L1-L4) bone mineral density (BMD) of 0.410 g/cm2 (cross on the reference database graph) measured by dual-energy x-ray absorptiometry and a T score of−5.79. The reference database graph displays age- and sex-matched mean BMD levels±2 SDs (shaded areas) derived from a normative database from the manufacturer, Hologic Inc, Waltham, Mass. T score indicates the difference in SD between the subject's BMD and the predicted sex-matched mean peak young adult BMD; Z score, the difference in SD between the subject's BMD and the sex- and age-matched BMD level; and % of mean, the subject's BMD as a percentage of the mean peak young adult BMD- or age-matched BMD level. Adapted from bone densitometry report, QDR-4500C bone densitometer; Hologic Inc.
Figure 3. Lateral Thoracic Radiograph Demonstrating a Thoracic Anterior Wedge Fracture
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