Middle Aged Woman with Colles Fracture

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Catherine A. Hammett-Stabler, Ph.D.

A 59-year-old Caucasian female was referred to an endocrinologist following treatment for a fracture to her left wrist. She reports that the fracture occurred approximately 2 months earlier when she tripped on a rough sidewalk and fell while walking her dog. She is otherwise in good health.

On physical examination, the patient is a 5-ft-tall, 94-lb middle-aged woman who describes herself as physically fit and in good health. She reports running 3-4 miles 3 times per week and participating in additional physical exercise that includes weight and resistance training. Her past medical history includes two full-term, uneventful pregnancies, menopause at age 41, but no history of thyroid disease, diabetes, or Cushing syndrome. A daily multivitamin supplement is her only current medication. She has never received hormone replacement therapy. She has no documented family history of osteoporosis, although she recalls her grandmother losing height as she aged and developing a dowager's hump, and notes that her 80-year-old mother appears to be losing height as well. The following laboratory results were obtained:

Reference

Value,

Interval,

Reference

Conventional

Conventional

Value, SI

Interval,

Analyte

Units

Units

Units

SI Units

Hemoglobin

13.9 g/dL

12-16

139 g/L

120-160

Hematocrit

40%

36-46

0.40 volume

0.36-0.46

Glucose

110 mg/dL

65-110

6.11 mmol/L

3.61-11.05

Creatinine

0.8 mg/dL

0.4-1.1

70.7 mmol/L

61.9-97.2

Urea nitrogen

14 mg/dL

7-21

5.0 mmol/L

2.5-7.5

Sodium

141 mmol/L

135-145

Same

Potassium

4.0 mmol/L

3.5-5.0

Same

Bilirubin, total

0.9 mg/dL

0-1.2

15.39 mmol/L

0-20.5

Calcium

9.1 mg/dL

8.5-10.2

2.28 mmol/L

2.12-2.55

Alkaline

287 U/L

30-120

4.88 mkat/L

0.51 -2.04

phosphatase

TSH

2.9 IU/mL

0.1-4.6

Same

25-Hydroxyvitamin D Urine free Cortisol Urine NTx

Value, Conventional Units

62 pg/mL 39.6 ng/mL 30 mg/24 h 178 mmol BCE/mmol creatinine

Reference Interval, Conventional Units

Value, SI Units

62 ng/L 99 nmol/L 82.8 nmol/24 h Same

Reference Interval, SI Units

At this time a dual-energy x-ray absorptimetry (DEXA) scan was performed to determine bone density:

Anatomic site BMD (g/cm2) Z-Score T-Score

On the basis of the bone density report and the clinical laboratory data, a diagnosis of primary osteoporosis was made. The patient was counseled to continue her current exercise program. Calcium citrate with vitamin D and a bisphosphanate, alendronate, was initiated. The patient was scheduled to return to the clinic in 3 months for a follow-up urine NTx.

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