study_ing
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A 60-year-old white female presents for an office visit. Her mother recently broke her hip, and the patient is concerned about her own risk for osteoporosis
She weighs 165 lb and is 5 ft, 6 in. tall. She has a 50-pack-year history of tobacco use. Medications include a multivitamin and levothyroxine
Her exercise regimen includes mowing the lawn and taking care of the garden. She took hormone replacement therapy for 6 years after[/left] [left]menopause, which occurred at age 49. In counseling this patient about osteoporosis, you should advise he that she might benefit from
a. Fluoride supplementation
b. Continuing her current exercise routine
c. Restarting hormone replacement therapy
d. none of the above
e. all of the above
Which of the following contributes to the development of osteoporosis?
[/left] [left]a. Family history of osteoporosis
[/left] [left]b. Hypothyroidism
[/left] [left]c. Obesity
[/left] [left]d. Use of hormone replacement therapy[/left]
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| MDcooper
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PART 2/;
hyper not hypothyroidism is associated with increased risk of osteoporosis.
HRT should help prevent osteoporosis.
Obesity increases the mechanical stress on already weakened bones but at the same time an obese woman has more estrogen,secondly lean and slender people are more prone to osteoporosis.
Family history definitely is a risk factor for osteoporosis.If your family has someone with hip fractures,u r more likely to get one too.
PART 1:
I think all of the above should be answer.Exercise definitely incrreases the bone mass at any age ,and we should excercise all our lives.osteoporosis is due to lack of minerals like Ca ,Vit D and others,So flouride replacement is also beneficial.and HRT is definitely helpful in a postmenopausal woman.
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| study_ing
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ure correct about the second one. 
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| MDcooper
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Hm I was a bit doubtful about flouride and heavy lawn mowing in an elderly lady...So I would go with HRT...But I am not sure if HRT at this age would help.I know bisphosphonates surely help(actonel)but its not there.So its eithe none of the above or HRT
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| study_ing
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Although fluoride is an osteoclast inhibitor, early studies revealed an increased fracture rate with fluoride supplementation for prevention or treatment of osteoporosis. Fluoride does not have a proven role in the prevention or treatment of osteoporosis.[
The current exercise regimen recommended is weight-bearing activities such as walking, dancing, tennis, or jogging three to five times per week. This patient is not performing adequate weight-bearing exercise
There is no indication at this time that the patient should restart hormone replacement therapy without further diagnostic testing. If this patient is diagnosed with osteoporosis, treatment options such as the bisphosphonates, calcitonin, selective estrogen modulators (SERMs), or hormone replacement therapy are available.
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| ssrpk
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so wht is it? none of the abv.... or HRT, besides HRT is for prevention of osteoporosis not treatment!
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| MDcooper
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I think it should be none of the above
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| study_ing
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Its d
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| Shaina
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sudying are you sure "d" is answer,that lady has been doing lawn moving,why not she continue doing it,its good advise right?? anyways wht's answer given as???
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| MDcooper
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hey in this case too pt is asking about prevention of osteoporosis,then ahy HRT is not the right answer here?
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| study_ing
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it was amild surprise to me too but that was the answer given.
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| study_ing
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shaina, b is not a weight bearing excercise. also swimming is thought to be good excercise but its not excercise which will benefit osteoporosis.
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| ssrpk
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now thats really confusing!
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| webjeee
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It is D.none of them.Fluoride can increase the BMD, but the quality of bone is still low, even lower, so not going to prevent osteoporotic fracture even with higher BMD after its use.Mowing is very dangerous for a menopausal woman with risk of osteoporosis, which even cause stress fracture as someone using electronic drill.Swimming is not weight bearing but it is helpful in prevent OP, because the contraction of the muscle really apply a lot of stress on the bone, and it is also a safe exercise, although its effect on OP is not that effective as weight bearing exercise.HRT is OK for her, but sort of dangerous to her with history of smoking, not only its notorious side effect, the formation of thrombosis risk is also high in her case. I think that's why the answer is D. Just my own opinion and experience (six years on OP), don't know the mainstream of OP therapy now in US.Hope it will help.
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| doc_clotaire
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It helps me Big time
Thanks !
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