Follow Up: Osteoporosis

Casebank Counselling
1

Where you are:
You are FY2 in Orthopaedic and Trauma Department

Who the patient is:
Deborah Jones is a 65-year old lady who has come for follow up.

Other information you have about your patient
She had a fracture of her right wrist 3 months ago which was treated successfully and she is now fine. She had undergone a DEXA scan while she was in hospital which showed osteoporosis.

What you must do
Talk to the patient about further management and address her concerns

Patient Information

  • You are Liz Jones, 65 years of age. You fell down in your back garden and sustained fracture of the right wrist.
  • It was a simple fall. You had a DEXA scan done but you don’t know the results yet.
  • LMP was 10 years ago.
  • Your mum has osteoporosis and she is on medications.
  • You are not sure of the name of the medications.
  • You had a hysterectomy 15 years ago but the ovaries were not removed.
  • You smoke 20 cigarettes a day since your university days.
  • You drink a bottle of wine every day.
  • You work as a school teacher.
  • You don’t have much time to eat so most of the time you eat takeaway food.
  • You have not been told that you have osteoporosis and you do not know what osteoporosis is.

Questions:

  1. Does osteoporosis run in the family?
  2. How would you treat me doctor?
  3. How do I take the Alendronic acid?
  4. Are there any side effects of osteoporosis?
  5. What is DEXA Scan?
    DEXA scan is to check the health of your bones

Setup

  • You have been placed in a cast.
  • You are lying on a bed in a hospital gown and you have a cast on your right hand.

Approach

  1. GRIPS ( Smile, Loud, Confident, Shake hands)
  2. Paraphrase the scenario: I understand that you sustained a fracture of your wrist couple of months ago?
  3. How are you doing now? I also understand that you had a DEXA scan done. Has anyone been here to explain the results of your scan?
  4. Did anyone explain to you why this scan was performed?
  5. Explain what osteoporosis is….This is a condition has weak bones.

Take history:

  • Family history of osteoporosis or fractures?
  • PMHX
  • Drug Hx
  • Previous operations (gynae operations?)
  • Any other fractures in the past?
  • Questions about lifestyle habit?
  • Were ovaries removed?
  • LMP?
  • Any menopausal symptoms? ( hot flushes, irritability)
  • Smoking?
  • Alcohol?
  • Diet?
  • Exercise?
  • Living Conditions/ Any help required at home?

Management of osteoporosis

  1. Diet: offer a diet sheet and refer to dietician
  2. Medications:
    • Vitamin D and Calcium tablets
    • Bisphosphonates (Alendronic Acid):
      • it prevents further fractures
      • it takes a few months to work
      • it makes the bones much stronger
      • you will be taking it once a week on the same day
      • you need to take it 30mls of water and swallow the whole tablet
      • take it on empty stomach
      • take it first thing in the morning
      • after taking the medication, wait for at least for 30minutes before eating or drinking anything. If you eat anything within the 30minutes, the medication will not get absorbed.
      • Stay upright for 30minutes.
      • Dose: 10mg OD or 70mg Weekly
      • S/e: Indigestion or heartburn: Talk to your GP
  3. Exercise
  4. Reduce alcohol
  5. Stop smoking
  6. Explain that having a family member with osteoporosis does put you at risk of osteoporosis.
2

OSTEOPOROSIS (DISCUSS TEST RESULTS)
As you enter the room and you already know the diagnosis your goal of your history, taking his number 1 to understand the risk factors of the condition,extent of the condition.

Before discussing may I know, may I ask you a couple of questions?I understand that you had a fracture two months ago.
Can you please tell me about it?
how are you doing?
now do you have any pain in your hand?
which hand was that by the way?
tell me how it happened? (I was working in my garden )I’m really sorry about that but I’m happy that you’re feeling better now.
M-any long standing medical condition
A-any allergies
F-family history of similar fractures?
Periods,Any hormone therapy,pap smear,

LIFESTYLE
D-i eat alot of feuits and veggies(wow im impressed)
E-may ik about ur physical activity -im run and stuff(wow it’s phenomenal,im really happy that u are an active person)
SA

Do u understand what scan we have done for u?its a dexa scan to check thickness of ur bone,it shows that ur bones are a bit thin. Its actually very common in women of ur age after menopause and u also mentioned ur mom had similar fracture so it runs in ur family aswell. Would u like to know what are we gonna do about it?
1st- prescribe alendronic acid(can i take w amlodipine?) - it shouldn’t cause any issues it should be okay.however ill make sure to check with bnf aswell to confirm
2nd - i would like to order vitD levels and Ca levels to check for deficiency.

Alendronic acid initially can cause some side effects like tummy upset. So u should take it 1st thing in the morning before breakfast with a full glass of water and as it can cause burning sensation so dont eat anything for 30 mins or lay down.make sure to sit straight

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