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Re: OsteoporosisFrom: ainsron (ainsron@sbcglobal.net)Thu Feb 10 08:49:47 2005
Has she been on steroids, or any signs of Cushings Syndrome? You need to look for other causes - check serum Calcium to exclude hyperparathyroidism, TSH to exclude hyperthyroidism, 25-hydroxyvitamin D to exclude vitamin D deficiency and 24 hr urinary calcium to assess malabsorption and renal abnormalities. Be sure she is taking 1200-1500 mg Ca and Vit D supplementation, 800 IU/d and weight bearing exercise. F/U BMD in 2 years. If she is truly taking her Fosamax, she may be a nonresponder, you could check a biochemical marker of bone resorption, if it is elevated significantly that could prove useful information. There is heterogeneity and markers often do not provide a clear-cut answer, but it may give you a reason to try another bisphosphonate, i.e. residronate. Teriparatide (human recombinant PTH) can be used in women who have failed or are intolerant to previous osteoporosis therapy, but it is quite expensive. You could consider Evista, clinical trials show decreased incidence of breast CA on women on it for 3 years. Ronald E. Ainsworth -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Elrod Darryl G MAJ 48 MDOS/SGOBO Sent: Thursday, February 10, 2005 6:35 AM To: Multiple recipients of list OB-GYN-L Subject: Osteoporosis I haven't seen many postmenopausal women in the last 4 years, so I'm asking for some advice. I have a 58 yo G3P3 with history of breast cancer and endometrial cancer that has been taking fosamax 70mg/wk for her 'prevention of osteoporosis.' She has had a mastectomy and TVH/BSO in the past. This was the first I had seen her, so I ordered a bone density scan since she hadn't had one in several years. Her T score was -2.6. Obviously, she is not a candidate for estrogen therapy. Now that she is clearly osteoporotic, what other options do I have in her treatment? Thanks, Glen D. Glen Elrod, Maj USAF, MC Obstetrician/Gynecologist Maternal Child Flight 48 MDOS/SGOBO UNIT 5210 Box 23 APO, AE 09464 DSN (314) 226-8334 Comm 01638-52-8334 Notice of Confidentiality Under the Privacy Act of 1974, you must safeguard all information reflected on this Email and, if applicable, all attachments. Disclosure of information is IAW AFI 33-119, AFI 33-127, AFI 37-131, AFI 37-132, AFI 33-219, and PL 93-579" This document may contain information covered under the Privacy Act, 5 USC 552(a), and/or the Health Insurance Portability and Accountability Act (PL 104-191) and its various implementing regulations and must be protected in accordance with those provisions. Healthcare information is personal and sensitive and must be treated accordingly. See <https://sg.usafe.af.mil/HIPAADisclosure.cfm> for full details.
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