Osteopetrosis Case Study

Osteopetrosis Case Study

Mrs. Pelletier is a 75 years old patient who presented to the health care provider's clinic with the chief care of back pain. The patient has a history of hypertension, hypothyroidism and Crohn’s disease. The patient complains of mild back pain for a week, exacerbated by standing and walking and alleviated by lying down. The patient rates the pain at 4 on a scale of 1 to 10. There is no history of trauma, but the patient broke her wrist a few months ago but cannot explain how it happened. The patient is known for lactose intolerance and is on medication including metoprolol, sulfasalazine, prednisolone and levothyroxine. The patient's vitals are normal except for blood pressure, which is slightly elevated, although the patient is a known hypertensive and hypothyroidism patient with Crohn's disease.

The healthcare suspects osteoporosis, which can be rationalized by the patient having the condition's risk factors. Being a female is the first risk factor for osteoporosis to the patient. Based on studies, women have a higher risk of developing osteoporosis than men (Sinaki, 2021). Secondly, Mrs. Pelletier's age is a risk for osteoporosis. As age progresses, an individual becomes more susceptible to developing osteoporosis, and it validated that the risk is higher above the age of fifty-five years. Additionally, the patient is on prednisolone, a corticosteroid that increases the risk of developing osteoporosis. Studies prove that corticosteroids weaken bones (Pouresmaeili et al., 2018).

Mrs. Pelletier is diagnosed with an endocrine condition which is hypothyroidism. It is researched and confirmed that patients with such endocrine conditions are at a higher risk of developing osteoporosis (Pouresmaeili et al., 2018). In addition to endocrine metabolism, the patient’s estrogen levels are lower at her age, additional risk of developing osteoporosis. The deficiency of estrogen is brought about by menopause. Being a lactose intolerant patient, the risk of developing osteoporosis is increased (Pouresmaeili et al., 2018). A lactose intolerance patient lacks calcium from dairy products because they do not take them. Lack of calcium in the bones makes them fragile to fractures and osteoporosis. Lastly, the patient has Crohn's disease, a bone-thinning condition; hence, osteoporosis may be a risk (Pouresmaeili et al., 2018). The conditions, drugs, status and diet determinants of Mrs. Pelletier are her risk factors for developing osteoporosis.

Diagnosis of osteoporosis is determined by a test and study on the bone density scan. The test is done to determine bone mineral density. The study is performed using a dual-energy x-ray absorptiometry. A bone density test is a confirmatory exam for osteoporosis done using bone densitometry (Sinaki, 2021). The sites for the study may be the spine or the hip, and the study effectively determines the risk of fracture occurrence and the need for treatment. Additionally, a calcium blood test may determine if the bones lose calcium. A vitamin D test can also be appropriate.

The patient's chief complaint is the main symptom of osteoporosis, which is back pain. The patient states that she has not experienced trauma or injury to the back, so it is a spontaneous pain. A fracture on the wrist with an unexplained cause is another clinical manifestation of osteoporosis for the patient (Sinaki, 2021). Studies have proved that a patient with osteoporosis often presents with hip, wrists, ribs and vertebrae fractures from small falls, and others are unexplained. The character o the pain the patient describes is typical for osteoporosis, one that is relieved by lying down and elevated on walking or standing. This is the cause that leads to a stooped posture in an osteoporosis patient. The risk of developing a curved spine is high with osteoporosis (Sinaki, 2021).

In the management of osteoporosis, alendronate is the drug of choice. In administering the drug, the healthcare provider should provide instructions to the patient on taking the drug. Mrs. Pelletier should be instructed to take the alendronate first thing early in the morning (LR et al., 2018). She should be instructed on taking the drug before they eat or drink thirty minutes earlier. If the drug is to be taken once a week, she should take it the same day and probably at the same time early in the morning.

Additionally, the drug should be taken with a full glass of water. The key instruction for taking alendronate to Mrs. Pelletier is that she should take it on an empty stomach because foods, beverages and other drugs like calcium and vitamins reduce the absorption of alendronate to the body (LR et al., 2018). If the patient has a caregiver, they should be instructed on administering the drug to the patient.

As a newly diagnosed patient of osteoporosis, nutritional needs education is important. The patient should be educated on taking calcium, vitamin D and proteins. For Mrs. Pelletier, she should be taught the need to take 800 international units of vitamin D daily, the calcium of at least 1000 milligrams per day and one gram per kilogram body weight of protein (Tu et al., 2018). Additionally, the patient should take calcium-fortified foods like soy, cereals, and tofu for nutritional needs. This patient also needs dark green vegetables like broccoli and kale. Mrs. Pelletier should take foods rich in calcium and vitamin D.

In addition to nutrition, the patient should also be educated on other important factors for improvement and treatment success. Exercise is one of the factors that the patient should be educated on. Mrs. Pelletier, despite being educated on the need for mild exercises, should avoid strong muscle and bone activity with rapid and jerky movements like running, jogging and jumping (Tu et al., 2018). This is because of their high risk of having fractures. The exercises should be slow and the movements controlled.

In conclusion, Mrs. Pelletier should also be educated on the need to avoid falls as they may result in fractures due to their delicate bones. Falls can be reduced by wearing shoes that fit well, getting up and walking slowly, and keeping all the walkways clear with proper lighting (Tu et al., 2018). Compliance with drugs is another important factor that the patient should observe and take as instructed to ensure the drug is well absorbed. The patient should maintain follow-up to check on the prognosis of the disease and the recovery process (Sinaki, 2021). Monitory treatment response is vital to see how well the medication is working and the need to reduce, increase or change it.

References

LR, W. P., & Preuss, C. V. (2018). Alendronate.

Pouresmaeili, F., Kamalidehghan, B., Kamarehei, M., & Goh, Y. M. (2018). A comprehensive overview of osteoporosis and its risk factors. Therapeutics and clinical risk management, 14, 2029.

Sinaki, M. (2021). Osteoporosis. In Braddom's Physical Medicine and Rehabilitation (pp. 690-714). Elsevier.

Tu, K. N., Lie, J. D., Wan, C. K. V., Cameron, M., Austel, A. G., Nguyen, J. K., ... & Hyun, D. (2018). Osteoporosis: a review of treatment options. Pharmacy and Therapeutics, 43(2), 92.