Solved

A 75-Year-Old Woman Comes to the Office for Follow-Up of Osteoporosis

question 744

Multiple Choice

A 75-year-old woman comes to the office for follow-up of osteoporosis. She has been on weekly oral risedronate for the last 2 years and has an adequate daily intake of calcium and vitamin D via diet and oral supplements. However, in the past year the patient has experienced 2 vertebral compression fractures and lost 5.1 cm (2 in) in height. She was evaluated in a fall reduction program, and home safety improvements were implemented. A home health aide assists the patient with her medications and notes that adherence has been excellent. Medical history is notable for a mild stroke 2 years ago with minimal residual deficits.
Vital signs are normal. BMI is 20 kg/m². On examination, the patient appears frail and has a modest thoracic kyphosis. Physical examination is otherwise normal.
Laboratory results show normal blood counts, liver function tests, serum creatinine, alkaline phosphatase, TSH, serum parathyroid hormone, anti-tissue transglutaminase antibody assay, 25-hydroxyvitamin D, and serum protein electrophoresis. 24-hour urine calcium excretion is 290 mg. DXA reveals a T-score of −2.8 in the hip and −3.6 in the spine, which represents a significant (>5%) decrease compared with her last test 2 years ago.
Which of the following is the most appropriate next step in management of this patient's osteoporosis?

Definitions:

Overweight

A medical condition characterized by excess body fat, which may negatively impact health, determined by measures like Body Mass Index (BMI).

Cerebral Palsy

A neurological disorder caused by a non-progressive brain injury or malformation that occurs while the child’s brain is under development, affecting body movement and muscle coordination.

Homosexual Behavior

Sexual or romantic activities involving individuals of the same sex.

Natural

Occurring in or derived from nature; not made or caused by humankind.