You are asked to see a 67-year-old woman who was recently discharged from the hospital following internal fixation of fragility fracture of left femoral neck. She had hypertension and primary hypothyroidism. Her medications include lisinopril 10 mg and L-thyroxine 100ug per day. Family history was unremarkable. On physical examination BMI 23.9 kg/m2 BP 130/84 mmHg. Laboratory studies showed: Serum creatinine 1.2 mg/dl Serum calcium 9.2 mg/dl: Serum PTH 69 pg/ml (N 10-58): Serum 25 hydroxy vitamin D 42 ng/mg (N 30-70): Serum TSH 1.9 mU/l (N 0.4-4.0 u): Bone density measured by DXA revealed: T score : Hip-2.9 Lumbar spine -2.7. In addition to vitamin D and calcium supplement, which of the following you recommend to reduce the incidence of another hip fracture?
A. Zoledronate 5mg IV yearly
B. Combined estrogen and progestin.
C. Raloxifene 60 mg per day.
D. Alphacalcidol 1 µg per day
Answer:A
You are asked to see a 67-year-old woman who was recently discharged from the hospital following internal fixation of fragility fracture of left femoral neck. She had hypertension and primary hypothyroidism. Her medications include lisinopril 10 mg and L-thyroxine 100ug per day. Family history was unremarkable. On physical examination BMI 23.9 kg/m2 BP 130/84 mmHg. Laboratory studies showed: Serum creatinine 1.2 mg/dl Serum calcium 9.2 mg/dl: Serum PTH 69 pg/ml (N 10-58): Serum 25 hydroxy vitamin D 42 ng/mg (N 30-70): Serum TSH 1.9 mU/l (N 0.4-4.0 u): Bone density measured by DXA revealed: T score : Hip-2.9 Lumbar spine -2.7. In addition to vitamin D and calcium supplement, which of the following you recommend to reduce the incidence of another hip fracture?
A. Zoledronate 5mg IV yearly B. Combined estrogen and progestin. C. Raloxifene 60 mg per day. D. Alphacalcidol 1 µg per day