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1. An x-ray examination of the thoracic spine reveals osteopenic changes at T7. What does this mean? Osteopenia means that the bone is thinning which could lead to fractures. Bone thinning leads to osteoporosis. Decreased bone density occurs as people age. BMD determines bone strength and it peaks around 25-30 years of age. After these peak years, bone breabsorption exceeds bone building which causes a decrease in bone density. Ignatavicius, D., D. & Workman, M., L. (2013).

2. The physician suspects osteoporosis. List seven risk factors associated with osteoporosis. Cigarette smoking Obesity Lack of exercise Postmentopausal Low calcium intake Low weight and BMI Alcohol and caffeine consumption Ignatavicius, D., D. & Workman, M., L. (2013).

3. Place a star next to those risk factors specific to M.S.

4. What tests could be done to determine whether M.S. has osteoporosis? Which tests is recommended and why? N-teleopeptide (NTX) and C-teleopeptide (CTX) are proteins released when bone is broken down. Increases levels of these markers indicate a risk for osteoporosis. A peripheral DXA scan assesses BMD of the heel, forearm, or finger. The Quantitative computed tomography (QCT) can also mearsue bone density and the peripheral quantitative ultrasound (pQUS) detects osteoporosis and it can predict risk for hip fracture. The most commonly used screening for measuring BMD is the dual x-ray absorptiometry (DXA). This tool is the best one for a definite diagnosis of osteoporosis. With this test the patient can stay dressed, which would be more comforting for the patient since she has not been to the doctor is eleven years. The patient will have to remove any metallic objects such as belt buckles, coins, keys, or jewelry because these objects may interfere with the test. Ignatavicius, D., D. & Workman, M., L. (2013).

5. M.S’s DEXA scan revealed a bone density of -2.6 SD. What does this mean? Osteopenia is present when the T score is at -1 and above -2.5. Since M.S’s DEXA scan showed a bone density of -2.6, she would be diagnosed with osteoporosis. Any score lower than -2.5 indicate osteoporosis. Ignatavicius, D., D. & Workman, M., L. (2013).

6. The physician orders alendronate (Fosamax) 70mg/wk. what instructions should you give M.S. regarding alendronate? Fosamax is a biphosphonate that is commonly used for the prevention and treatment of osteoporosis. It would be best to take Fosamax on an empty stomach with plenty of water. Do not lie down or eat for at least 30 minutes after taking the pill. The side effects for Fosamax are abdominal pain, bone/skeletal pain, constipation, diarrhea, dyspepsia, and nausea. I would also tell M.S that osteonecrosis of the jaw may occur after dental extraction, root canal, dental implant or other oral surgeries. Lastly I would tell M.S. that oral biphosphonates are commonly associated with a serious problem called esophagitis which is inflammation of the esophagus. If chest discomfort occurs which is a symptom of esophageal irritation, she should discontinue the drug and contact her health care provider. I would assess her for poor renal function, hypocalcemia, and GERD because if she has any of these, she would not be able to take Fosamax. Ignatavicius, D., D. & Workman, M., L. (2013).

7. What nonpharmacolocic interventions should you teach M.S. to prevent further bone loss? I would recommend decreasing caffeine intake, stop smoking, strength training exercises, walking, eat dark green leafy vegetables for calcium, avoid jarring activities such as horseback riding, get at least 5 minutes of sun exposure per day to activate the vitamin D to help absorb the calcium, and to read the food labels to make sure she increases the calcium intake. Ignatavicius, D., D. & Workman, M., L. (2013).