Title: November 2014 – Marked unexplained changes in BMD on therapy

Submitted by Larry Jankowski, CBDT

Brief History:

A 68 year old active, white female, who runs and lift weights five days a week, who was switched to continuous hormone replacement (estradiol patch, and oral progesterone) three years ago after stable BMD was seen on a DXA after 5+years of intermittent use of oral and IV bisphosphonates. The patient was concerned about the potential risks of long-term bisphosphonate exposure for atypical femur fractures and osteonecrosis of the jaw. She returns for a bone density assessment to assess the efficacy of her HRT. She is 67.5” (maximum height was 68.5”), and 131 pounds with a BMI of 20.2. She was gowned and asked to remove any undergarments that contained metal, hard plastic, or tight elastic (e.g. underwire bra or girdle).

Other risk factors: Premature natural menopause at age 38, IBS with a 40 pound weight loss since 2003, and lower lumbar scoliosis discovered in early adulthood.

The analysis of her original baseline DXA in 2003, and last two DXA scans (2010 and 2013) of the right hip and spine are shown here.

october-14-1

Questions:

  1. What is her current WHO diagnositic category?
  2. Is this patient’s BMD stable (or improving) after switching from bisphosponates to HRT?
    (LSC’s:Total hip = 0.019 g/cm2, Femur neck = 0.025 g/cm,2, L1-L2 = 0.029 g/cm2)

 

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