Case Study A: Mr. P tripped and broke her left hip while attempting to go to the bathroom in the middle of the night. Prior to this episode, she has been living alone and spend most of her days watching television. She last presented 3 months ago after she has had a fall at home. At that time, she had no serious injuries. Mrs. P was taken to surgery and underwent an ORIF for her fracture. She did well post-op and was discharged to a rehab facility. The physician overseeing her rehab started her on alendronate once a week in addition to calcium with vitamin D. Youre the discharging nurse and Mrs. P has questions about her new medications. Answer each question: Case Study B: Mrs. Davis presented to the clinic in December of 2010 with some concerns about osteoporosis. She was becoming more stooped and had already lost 1 in height over the last few years. She was 20 years postmenopausal and had never taken hormone replacement therapy. She subsequently received a DEXA scan at that time and was placed on Fosamax 10 mg daily. Over the next year, this seemed to be working well for her and she did not experience any side effects from the medication. In the fall of 2011, she sustained a fracture to her 4th metacarpal on her left hand that she suffered during a fall. She received another DEXA scan in late 2011 with no change. She seemed fairly stable and was only seen yearly after that time. During a repeat exam in 2013, DEXA scores continued to show progression and she was subsequently referred to an endocrinologist to eliminate secondary causes. After a thorough work-up, no cause was found for her worsening osteoporosis. Thyroid studies were normal as well as serum phosphorus, PTH and urine calcium. suggestion was made to switch to weekly Fosamax; however, this was not tolerated well and she remains on Fosamax 10 mg q.d. 1. Identify and discuss at least 6 risk factors in Mrs. Davis history that predispose her to osteoporosis. (3 points) 2. Which of those risk factors are intrinsic and not amenable to change? Which are extrinsic and can be modified? (2 points) 3. Evaluate her calcium intake from her diet and supplements; is it adequate for her age and menopausal status? (1 point) 4. Formulate a recommendation for vitamin and mineral intake for Mrs. Davis, including specific compounds, doses and directions. (2 points) 5. Evaluate Mrs. Davis level of physical activity and make any recommendations you think necessary. (2 points).

1. Case Study A:
Mr. P tripped and broke her left hip while attempting to go to the bathroom in the middle of the
night. Prior to this episode, she has been living alone and spend most of her days watching
television. She last presented 3 months ago after she has had a fall at home. At that time, she had
no serious injuries.
Mrs. P was taken to surgery and underwent an ORIF for her fracture. She did well post-op and
was discharged to a rehab facility. The physician overseeing her rehab started her on alendronate
once a week in addition to calcium with vitamin D.
Youre the discharging nurse and Mrs. P has questions about her new medications. Answer each
question:
Case Study B:
Mrs. Davis presented to the clinic in December of 2010 with some concerns about osteoporosis.
She was becoming more stooped and had already lost 1 in height over the last few years. She
was 20 years postmenopausal and had never taken hormone replacement therapy. She
subsequently received a DEXA scan at that time and was placed on Fosamax 10 mg daily. Over
the next year, this seemed to be working well for her and she did not experience any side effects
from the medication. In the fall of 2011, she sustained a fracture to her 4th metacarpal on her left
hand that she suffered during a fall. She received another DEXA scan in late 2011 with no
change. She seemed fairly stable and was only seen yearly after that time. During a repeat exam
in 2013, DEXA scores continued to show progression and she was subsequently referred to an
endocrinologist to eliminate secondary causes. After a thorough work-up, no cause was found for
her worsening osteoporosis. Thyroid studies were normal as well as serum phosphorus, PTH and
urine calcium. suggestion was made to switch to weekly Fosamax; however, this was not
tolerated well and she remains on Fosamax 10 mg q.d.
1. Identify and discuss at least 6 risk factors in Mrs. Davis history that predispose her to
osteoporosis. (3 points)
2. Which of those risk factors are intrinsic and not amenable to change? Which are extrinsic and
can be modified? (2 points)
3. Evaluate her calcium intake from her diet and supplements; is it adequate for her age and
menopausal status? (1 point)
4. Formulate a recommendation for vitamin and mineral intake for Mrs. Davis, including specific
compounds, doses and directions. (2 points)
5. Evaluate Mrs. Davis level of physical activity and make any recommendations you think
necessary. (2 points)