Case 0101: William
Patient: William P., a 64 year old male physician

Principal Complaints: Osteoporosis, hypertension and obesity.

History:
Two years ago William was evaluated for osteoporosis. His mother is severely affected and his physician noted a slight loss of height (1/2 inch). Bone Densitometry showed borderline osteopenia. William was started on Calcium supplements (1200 mg/day) and Vitamin D (400 IU/day). Plans were made to follow up with another bone scan in 2 years.
William also wanted to lose weight so he began a daily walking program and followed a meal plan. In the first six months he lost about 5 pounds. Over the winter he got out of the habit of walking but he has been following the meal plan. He has regained the 5 pounds he lost and an additional 6 pounds in the last two years.
The results from the bone scan taken 2 years after calcium supplementation show a slight worsening of the condition.
At this appointment William says he has modified his diet by adding a SlimFast shake instead of the muffin he has been eating for his morning snack and he would like to resume an exercise program that includes some resistance exercise as well as walking.

Significant observations from the physical exam:

Alert and oriented overweight male.

Blood pressure 132/80.

Weight: 220 lbs.
Height: 5’9. 5"
BMI: 32.07

Current medications:

Maxzide (25 mg hydrochlorothiazide, 37.5 triamterene) http://home.mdconsult.com/das/drug/view/1/1465/top?sid=32055428
Centrum Senior multivitamin/mineral supplement
Vitamin E 400 IU
Aspirin 325 mg every other day
Vitamin C 250 mg
Calcium 1200 mg
Vitamin D 400 IU
Selenium 200ug

Laboratory tests:

Bone Densitometry
Standard Deviation
+1.0 to –1.0 is normal
-1.0 to –2.5 represents osteopenia with mild to moderate increased risk of fracture
Values less than –2.5 represents osteoporosis with significant increased risk of fracture.

Age 61 (scan from two years ago)

Lumbar Spine Left Hip
BMD 0.971 0.980
Percent Young Adult 89% 91%
Standard deviation -1.09 -0.70

Conclusion: there is no evidence of osteoporosis or osteopenia with in the left hip.
There is borderline osteopenia within the lumbar spine indicating a mild to moderate increased risk of future fracture although accumulative data are based on abnormalities predominantly within the bodies of L3 and L4

Age 63 (Most recent Scan)

Lumbar Spine Left Hip
BMD 0.961 0.742
Percent Young Adult 88% 80%
Standard deviation -1.19 -1.38

Impression: The findings indicate osteopenia involving the spine and left femoral neck. Overall some worsening noted since the prior exam. There is mild to moderate risk of fracture at these sites.

Diet History and Analysis:

Two years ago

Today

Treatment Plan:

Fosamax (10 mg/day): http://home.mdconsult.com/das/drug/view/1/3232/top?sid=31993643

Calcium Supplementation?

Potassium intake?