Question

Yvonne is a motivated patient who understands her bone condition well. She in unable to tolerate bisphosphonates (and has tried 3). She has had 3 spontaneous fractures (2 vertebral compression fractures and a hip fracture) in the past 3 years, and her T-score remains at -2.7. While in the hospital for the hip fracture, she developed a pulmonary embolism. Which of the following is her classification based on T-score and a reasonable next step?

A) Osteopenia; increase calcium and vitamin D
B) Osteoporosis; switch to raloxifene
C) Severe osteoporosis; switch to romosozumab
D) Severe osteoporosis; Review lifestyle changes and continue bisphosphonates

Answer 1

Yvonne's condition is classified as Severe Osteoporosis, and a reasonable next step, considering her intolerance to bisphosphonates and recent fractures, would be switching to romosozumab, a different osteoporosis medication.

Step-by-step explanation:

Based on the information provided, Yvonne's classification based on her T-score and her medical history is Severe Osteoporosis. A T-score of -2.7 constitutes osteoporosis, and with a history of multiple spontaneous fractures and the inability to tolerate bisphosphonates, along with her recent pulmonary embolism, her osteoporosis can be classified as severe.

Given her intolerance to bisphosphonates, a reasonable next step in her treatment plan would be to switch to a different medication indicated for severe osteoporosis, such as romosozumab, which is an option for patients at high risk of fracture who are unable to tolerate bisphosphonates or for whom bisphosphonates are contraindicated or ineffective.