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  #1  
Old 09-24-2012
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Question Old Man with a recent Fall

A 77-year-old man who is a NH resident is evaluated for recent fall. He has some neuropathy and some decreased quad strength. He has a DEXA scan done with a T score at the spine of < - .8 and < - .6 at the hip. He has a Hx of HTN and GERD.
What would you recommend for the appropriate next step?
A. Begin teriparatide
B. Begin alendronate
C. Begin hydrochlorothiazide
D. Recommend special shoes
E. Check Vitamin D level
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Old 09-24-2012
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I would recommend special shoes, seeing he has neuropathy and in danger of developing charcot joint.

His dexa scan results are normal, he is not even osteopenic so there is no need to give teriparatide nor alendronate

He has a history of GERD and biphosphonates are known to cause severe esophagitis if not enough water is taken with them.

There is no reason to check vitamin D levels ...

His fall was probably due a combination of factors that include old age, neuropathy, bad luck etc.
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Old 09-24-2012
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Quote:
Originally Posted by tyagee View Post
A 77-year-old man who is a NH resident is evaluated for recent fall. He has some neuropathy and some decreased quad strength. He has a DEXA scan done with a T score at the spine of < - .8 and < - .6 at the hip. He has a Hx of HTN and GERD.
What would you recommend for the appropriate next step?
A. Begin teriparatide
B. Begin alendronate
C. Begin hydrochlorothiazide
D. Recommend special shoes
E. Check Vitamin D level
E. Check Vitamin D level

NH residents hardly get to be in the sun and are usually deficient.
Vitamin D Deficiency is a cause of proximal muscle weakness.

Quote:
......as people with poorer health are likely to remain indoors, receive less sun exposure, and have low 25OHD levels compared to their healthy peers
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Old 09-24-2012
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ans B .........
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  #5  
Old 09-25-2012
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Quote:
Originally Posted by Novobiocin View Post
E. Check Vitamin D level

NH residents hardly get to be in the sun and are usually deficient.
Vitamin D Deficiency is a cause of proximal muscle weakness.
Ur ans is correct. What is nh resident ?
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Old 09-25-2012
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Quote:
Originally Posted by tyagee View Post
Ur ans is correct. What is nh resident ?
nh resident = nursing home resident
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