Title: April 2015 – The Ristelton Effect

Submitted by Larry Jankowski, CBDT

Brief History:

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?

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