Pt with significantly worsening in T-score from previous DEXA scan. Now -2.3 from -1.5.
Nonpharmacologic therapy to reduce fractures reviewed and encouraged.
Denies any issues with her jaw – no jaw pain. She also denies any history of gastritis or esophagitis.
Choosing to pursue bisphosphonate therapy.
Will check 25-Hydroxyvitamin D, calcium levels, and renal function (CMP) today and initiate bisphosphonate therapy at next visit.
Education provided about the problem, alternative treatment, risks, and benefits of treatment.
Patient to take with water, 30 min before first food/drink/med, avoid lying down for 30 min. Calcium and Vit D supplementation will be provided. Will periodically reassess the need for tx and consider drug holiday if stable after tx for 5 years for low-mod risk patient or 6-10y for high-risk patient.
