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1. CASE STUDY
PATIENT WITH
OSTEOPOROSIS & RISK OF
FRACTURE
URDU/HINDI
INSTRUCTOR:
MUHAMMAD SAQUIB QURESHI
PHARMACIST BY EDUCATION

2. Case History
Mrs. Ashish is a 66-year-old white woman who was
brought to the Emergency Department by her daughter
after her slipped in the shower. She had an x-ray of her
right hip and leg. No fractures were noted, but the
radiologist reported signs of osteoporosis in her hip. She
has a medical history of hypertension and rheumatoid
arthritis, for which she takes hydrochlorothiazide 25 mg
orally daily and methotrexate 20 mg orally weekly. She also
reports taking naproxen 500 mg orally twice daily but no
other OTC medications.
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3. What recommendations regarding
pharmacologic treatment would you
provide to Mrs. Ashish to manage her
osteoporosis?

4. EXTRACTION OF INFORMATION FROM CASE HISTORY
CLINICAL EXAMINATION
NECESSSARY ACTION AS PER DATA COLLECTED
MONITORING OF PATIENT
PROVISONAL DIAGNOSIS

5. EXTRACTION OF INFORMATION FROM CASE HISTORY
• AGE 66 YEARS
• FEMALE
• EMERGENCY DEPARTMENT AS SHE SLIPPED DURING
SHOWER
• NO FRACTURE OBSERVED
• MEDICAL HISTORY OF HYPERTENSION & RHEUMATOID
ARTHRITIS
• TAKING METHOTREXATE and NAPROXEN.

6. CLINICAL EXAMINATION
According to guidelines on the treatment of
osteoporosis to prevent fractures in men and women,
the American College of Physicians (ACP) recommends
that clinicians offer pharmacologic treatment with
Alendronate, Risedronate, Zoledronic acid, or
Denosumab to reduce the risk of hip and vertebral
fractures in women who have known osteoporosis

7. NECESSSARY ACTION AS PER DATA COLLECTED
• The pharmacist could recommend
Alendronate 70 mg orally once weekly as
first-line therapy.
• Calcium and vitamin D supplementation is
also recommended if dietary intake is
inadequate.

8. WHY ALENDRONATE?

9. Zoledronic acid is associated with arthritis and
arthralgias, making it a less-attractive choice to
initiate in Mrs Ashish, who suffers from rheumatoid
arthritis.
Additionally, she takes the immunosuppressive
agent methotrexate. Because denosumab is
associated with an increased risk of infection, it
would not be the optimal choice for her.
Alendronate and risedronate are both supported
by high-quality efficacy and safety data, but
alendronate is considerably less expensive.

10. MONITORING OF PATIENT
The patient being monitored on the therapy and
significant changes were observed.

11. PROVISIONAL DIAGNOSIS
She was diagnosed with Osteoporosis and Risk of Hip or
Bone Fracture.

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