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Clinical Crossroads Update
November 11, 2009

Update: A 55-Year-Old Woman With Osteopenia

JAMA. 2009;302(18):2023-2024. doi:10.1001/jama.2009.1647

In a December 2006 Clinical Crossroads article,1 Steven R. Cummings, MD, discussed a 55-year-old woman with low bone mineral density (BMD). Ms Q had her first BMD study in 2000, when her T score was −1.4 at the spine and −0.6 at the total hip. Having taken postmenopausal hormone therapy for breast cancer risk reduction since 1999, as was the practice until trials demonstrated that it had the opposite effect,2 she continued taking daily estrogen and medroxyprogesterone acetate. In 2001, Ms Q began to experience trouble with her balance. A neurological examination revealed that she had had several tiny strokes. An evaluation revealed a small atrial septal defect and a weakly positive test for antiphospholipid antibody. As a result, Ms Q discontinued hormone therapy, was prescribed dose-adjusted warfarin, and began physical therapy; her next neurological examination result was normal. Ms Q had BMD testing in 2003 and again in 2005. Between tests, her total hip T score declined from −0.7 to −1.0 and her anterior-posterior spine (L1-L4) declined from −1.9 to −2.3. Ms Q is an avid golfer (when weather permits) and takes 1500 mg of calcium and a multivitamin daily.

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