Gen: Well developed Caucasian woman in no acute distress

VS: BP 122/66, P 77, RR 16, T 36.3°C (97.3°F), wt 55.4 kg (122 lb), ht 5'31/2" (161 cm)

Chest: Decreased breath sounds bilaterally, air movement decreased; no rales or rhon-chi

CV: RRR, normal Si, S2; no murmurs, rubs, or gallops

Abd: Soft, nontender, nondistended; normal bowel sounds, no hepatosplenomegaly Ext: No clubbing, cyanosis, or edema Labs: Within normal limits Bone Densitometry by DXA

• BMD of lumbar spine: 0.683 g/cm ; T-score: -3.3

What additional risk factor and signs of osteoporosis are present in this patient?

What are the goals of pharmacologic and nonpharmacologic therapy?

List at least three nonpharmacologic interventions important in her treatment plan.

What factors support pharmacotherapy for osteoporosis in this patient?

What type of calcium supplement would you recommend for this patient? Why?

Vitamin D is often combined in varying amounts with calcium salts. A multiple vitamin is another good source of vitamin D. Most multivitamins contain 400 IU per tablet. Vitamin D is also available as a single entity. To avoid hypercalciuria and hypercalcemia, the maximum recommended dose for most patients is 2,000 IU/day. Ergo-calciferol (vitamin D2) and cholecalciferol (vitamin D3) are available in higher doses and are generally reserved for patients with vitamin D deficiency.

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