Case Study

Description

You enter Exam Room 1 to find Ms. Ho, a 58-year-old Chinese female. She is here for a follow-up appointment. She broke her wrist a few months ago and is here to check on the progress and to undergo some additional tests. Ms. Ho is a relatively healthy woman who likes to swim, but admits that she hasn’t been exercising like she used to. She eats lots of vegetables and seafood, avoids most dairy products, seldom drinks, and she smokes (she’s been trying to quit for years). She went through menopause at the age of 51. Today she is feeling pretty good but has some lower back pain, and is concerned about her wrist because when her mother got older she suffered from two broken hips.
BMI (5’0″, 88#s) 17.2
B/P 100/66

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Labs include:
Serum Thyroxine T4 9.0 ug/dl
Thyrotropin (TSH) 3.4 IU/ml
Serum triiodothyronine T3 120 ng/dl
Hematocrit 37%
Hemoglobin 11.8 g/100ml
Glucose 86 mg/dl
Blood Sodium 139 mmol/L
Blood Potassium 3.9 mmol/L
Blood Calcium 8.8 mg/dl
Vitamin D 27.5 ng/ml
24-hr urine calcium 382 mg/day
Bone density scan T-score -3.5

1. Based on the lab results, are any of Ms. Ho’s value abnormal?
2. What is your differential diagnosis of Ms. Ho? What information/data leads you to this diagnosis?
3. How would you describe your prime diagnosis and risk factors of this disease to the patient?
4. What plan would you suggest and why?
5. Patients with this condition are often told to take calcium and Vitamin D supplements. According to NIH, what are the standard doses for these two supplements?
6. What role do calcium and Vitamin D play in bone health?

Sample Solution

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