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Old 10-17-2011
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Default Endocrine

A 66-year-old African American woman comes to your office after bone density testing reveals osteoporosis. She has hypothyroidism, for which she has taken thyroxine for many years, but she has not kept regular appointments to follow up. She had a hysterectomy at the age of 43 and she has been on estrogen replacement therapy since the age of 47. She takes a daily calcium supplement. She exercises somewhat regularly. She does not smoke or use alcohol or drugs. Physical examination, including breast and pelvic exams, is normal. Which of the following factors is most likely adversely affecting bone mass in this patient?



A.

African American race


B.

Calcium supplementation


C.

Estrogen replacement therapy


D.

Exercise


E.

Thyroxine
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Old 10-18-2011
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ans E . i think . ovr treat wid l-thyroxine will act lik thyrotoxicosis. its leads to osteoporosis.. m nt sure, anyone else?/
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Old 10-18-2011
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i think its thyroxine since tht has not been monitored so overdosing is the issue
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Old 10-18-2011
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E.

Thyroxine
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Old 10-18-2011
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E. Thyroxine.
It has not been monitored properly and excess thyroxine is causing this.
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Old 10-18-2011
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Correct Answer Answer

The correct answer is E. Numerous factors affect a person’s bone mass. It is important to recognize these factors and modify those that can be modified in order to prevent osteoporosis. Cigarette smoking, excessive alcohol use, and high caffeine intake appear to decrease bone mass and increase fracture risk. Dietary calcium intake is an important determinant of bone mass. It is essential to have adequate calcium intake from childhood onward. Vitamin D intake is also essential. Family history is an important but unmodifiable risk factor. African American women have a lower risk of osteoporosis than do white and Asian women. Genetic factors also appear to play a significant role, with female children of women with osteoporosis having lower bone mass compared with female children of women without osteoporosis. In terms of medications, estrogen, progesterone, calcium, and vitamin D have all been shown to help increase bone mass. Thyroxine replacement that suppresses thyroid-stimulating hormone (TSH) has been associated with decreased bone density. This has been demonstrated at doses of 200 μg or more daily. Similarly, hyperthyroidism itself is also associated with decreased bone mass.
African American women (choice A) are more likely to have increased bone mass and a lower risk of osteoporosis compared with women who are white or Asian.
Calcium supplementation (choice B) has been shown to be helpful in increasing bone mass and decreasing bone loss. It does not adversely affect bone mass.
Estrogen replacement therapy (choice C) will help to prevent osteoporosis and bone loss in women.
Exercise (choice D) has been shown to help improve bone density and to prevent osteoporosis. The best exercise for bone strength is weight-bearing exercise such as walking or jogging. Exercise is also beneficial because it helps people with their balance and coordination. Improved balance and coordination are useful in avoiding falls that can lead to hip and vertebral fractures.
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