The Approach to Osteoporosis in the Elderly Patient

Abstract

Mrs F. is a thin 85-yr-old widow living alone in a small apartment. She is independent in her activities of daily living, but receives some assistance with heavy housework. She manages all of her own affairs, has been in relatively good health, but her family has noted increasing forgetfulness. She has osteoarthritis in the right knee, hypertension treated with a calcium channel blocker, and insomnia treated with temazepam. Mrs F. underwent a hysterectomy at age 45 for fibroids and never received hormone therapy. She eats three meals a day, but has never tolerated milk or dairy products because of gastrointestinal distress, and she hesitates to go out into the direct sunlight because she is fair-skinned. She has never had a fracture. For several days, she had been experiencing urinary frequency. One morning, she awoke with an urgency to void and stood up quickly to proceed to the toilet. Because of the pain from her arthritic knee, she had trouble getting up and the rug next to her bed slid out from under her. She fell to the side, landing on the left hip, but was unable to get up to call for assistance because of pain. Her home health aid came to the house later that day and found her on the floor. She was taken to the hospital where an X-ray of the left hip revealed a femoral neck fracture. She was hospitalized for 4 d, and was discharged to a rehabilitation facility. By the end of her 30-d stay, she was able to ambulate with a walker, and was discharged to her own apartment with a visiting nurse