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Clinical Crossroads
April 28, 1999

A 73-Year-Old Woman With Osteoporosis

Author Affiliations

Author Affiliation: Dr Greenspan is Director, Osteoporosis Prevention and Treatment Center, Director, Bone Density Testing Center, Program Director, Harvard-Thorndike General Clinical Research Center, Beth Israel Deaconess Medical Center, and Associate Professor of Medicine, Harvard Medical School, Boston, Mass.


Clinical Crossroads at Beth Israel Deaconess Medical Center is produced and edited by Thomas L. Delbanco, MD, Jennifer Daley, MD, and Richard A. Parker, MD; Erin E. Hartman, MS, is managing editor. Clinical Crossroads section editor: Margaret A. Winker, MD, Deputy Editor, JAMA.

JAMA. 1999;281(16):1531-1540. doi:10.1001/jama.281.16.1531

DR DALEY: Mrs Z is a 73-year-old married grandmother who lives in a suburb of Boston, Mass, with her husband. She works 4 days per week in her daughter's retail business. Her gynecologist recently referred her for evaluation of "thin bones." Mrs Z has medical insurance through Medicare and supplemental insurance.

Mrs Z underwent menarche at age 11 years and had normal menstrual periods until menopause at age 50 years. She had 2 uncomplicated pregnancies and took oral contraceptives for many years. After menopause, she took hormone replacement therapy (HRT) for only 3 years, then stopped because of fear of developing breast cancer. She smoked for 1 year in her teens and quit; she does not drink alcohol. She has never taken glucocorticoids, anticonvulsants, or thyroid medication. Her mother fractured her hip twice. There is no family history of breast cancer. The patient's daily dietary calcium intake is low, about 300 mg/d, but she has taken supplemental calcium tablets of about 1200 mg/d for the past several years. She has never had a kidney stone.

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