OSTEOPOROSIS CONSULT

Dear Dr. Smith, I had the pleasure of seeing your patient today in consultation for assistance with osteoporosis management. Past medical history: The patient has a history of rheumatoid arthritis and hypertension. Fracture history: The patient experienced a wrist fracture in 2018 and a vertebral fracture in 2020. Medications: Current medications include Alendronate, Methotrexate, and Lisinopril. Past medications relevant to bone health include Calcium supplements. Allergies: The patient is allergic to penicillin. Habits: The patient consumes alcohol occasionally and does not smoke. Social: The patient is a retired school teacher and lives with her spouse. Family history: There is a family history of osteoporosis in the patient's mother and a hip fracture in her grandmother. History of presenting illness: The patient reports increasing back pain over the past six months. Risk factors for osteoporosis include long-term steroid use and post-menopausal status. Dietary calcium intake is low, and the patient has been post-menopausal for 10 years. Previous treatment for osteoporosis included bisphosphonates. Physical examination: height: 165 cm weight: 70 kg ribbed pelvis distance: 2 cm occiput to wall: 5 cm Investigations: Recent DEXA scan shows a T-score of -2.5 at the lumbar spine. Impression and plan: Assessment for secondary causes with specific blood work including serum calcium, vitamin D, and thyroid function tests. Vertebral x-ray to assess for any new fractures. Treatment plan includes continuation of Alendronate, addition of vitamin D and calcium supplements. Follow-up on mineral density test in one year. CAROC and FRAX calculation indicate a high risk of fracture. Thank you for the referral. Sincerely, Dr. Emily Johnson, MD