Mixed Practice 67

A 65-year-old woman is seen to review results of a bone mineral density test ordered because of a 1 cm loss in height over the past few years. She went through menopause at 51 and took combined hormone therapy for 2 years. Her mother had osteoporosis. She does not smoke, drinks one glass of wine per week, has a BMI of 24 kg/m2, and has no history of fractures or falls. Her medications are a calcium carbonate supplement and lorazepam 0.5 mg at bedtime, which she has taken for 5 years. She lives in a two-storey house with several throw rugs. Bone mineral density shows a lumbar spine T-score of -2.5 and a femoral neck T-score of -2.1. Calcium, phosphate, creatinine, alkaline phosphatase, CBC, TSH and 25-OH vitamin D are all within normal limits (eGFR 88 mL/min/1.73 m2; 25-OH vitamin D 68 nmol/L). A diagnosis of osteoporosis is made.