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Case Study 2
A 61-year-old woman on
HRT for 15 years
Patient profile
Nancy C. is a 61-year-old, unmarried, nulligravida,
Caucasian female, who works as a
buyer for a large department store chain. She
has been on HRT (most recently conjugated
estrogens 0.625 mg/medroxyprogesterone
2.5 mg) for 15 years. She is 5' 2 3/4" in
height (formerly 5' 3") and 220 lbs in
weight. Her history includes hypothyroidism,
kidney stones, gastroesophageal
reflux disease (GERD), and surgery on her
left foot. Her current medications include
levothyroxine sodium, fexofenadine HCl,
lansoprazole, calcium, and vitamin D. Her
father died of an aneurysm at age 85; her
mother is alive and well, with a heart valve
replacement. Nancy stopped taking HRT
after news was released about the WHI
results. However, she has always taken an
active role in matters regarding her health
and was determined not to be at risk for
fractures. After consultation, her physician
referred her for a BMD test; the results are
shown in Table 2.
Discussion
Bone mass accounts for approximately 80%
of bone strength and is the single strongest
predictor of osteoporotic fractures in postmenopausal
women. The availability of
simple and safe methods for measuring
BMD make it possible to detect osteoporosis
in its earliest stages and monitor the
effectiveness of treatment. Knowledge of
bone density also appears to enhance
patient compliance with therapies for the
prevention and treatment of bone loss.
Ideally, bone densitometry would be available
for all postmenopausal women. In
practice, cost-containment issues have led
various organizations to develop guidelines
limiting its use. Medicare, for example,
covers bone densitometry for all estrogendeficient
women over age 65. In general, it
is reasonable to measure bone density in all
Caucasian women over age 60-65 regardless
of risk factors.
Healthy women between
the ages of 50 and 65 should also be tested if
they have a history of low trauma fracture,
weigh < 127 lbs, if they smoke, have a
family history of osteoporotic fracture, or
if they have a known secondary cause of
bone loss.
Nancy C. was judged not to be at high risk
for fracture. She was encouraged to continue
calcium and vitamin D along with
initiating an exercise program. Her BMD
test will be repeated in two to five years.
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