Submitted by Larry Jankowski, CBDT
A 58 year old Caucasian female, height 61.5”, weight 141lbs (BMI = 26), 1 year post-menopause. Pt was on an estrogen patch for one year during the menopausal transition but discontinued it one year prior the most recent DXA scan which showed a significant loss of BMD at the spine and a diagnosis of osteoporosis. She was prescribed generic alendronate for 6 weeks but discontinued after developing severe epigastric pain. Due to her dramatic loss in spine BMD and intolerance to oral bisphosphonate, she was referred to a rheumatologist for metabolic evaluation. The report of her most recent DXA scan was provided to the rheumatologist and reproduced below:
- Based on the rapid loss seen at only the lumbar spine, what are possible eitiologies to explain a 33% loss in the 3.5 year interval between scans?
- What test(s) would you order next?