Osteoporosis Case study
Subjective exam:
58 year old female
Height/weight: 5’5” (5’6” at age 18); 115 lbs
Occupation: file clerk; currently off work due to injury
Chief complaint: 8 weeks s/p right distal radius fracture following a fall on an outstretched hand (tripped on a
crack in the side walk)
PMHx: Hysterectomy and bilateral oophorectomy (removal of ovaries) at age 45 due to ovarian cancer;
chemotherapy post surgery. No Hormone Replacement Therapy prescribed. DEXA scan has not been done.
Asthma since childhood.
Sx behavior:
Right wrist pain, 4/10 at most, 0/10 at best
Aggs: ADL’s that involve wrist use; lifting coffee mug
Eases: rest; sx ease 10 minutes after stopping aggravating activity
24 hours: Awakens 2x/night to use the restroom; awakens with wrist soreness
Function: Enjoys crafts and reading. Generally sedentary lifestyle, but is motivated to increase her activity.
Objective exam:
Observation: Posterior pelvic tilt, minimally increased thoracic kyphosis, forward head, protracted shoulders,
slight forward bend of the trunk. Carries her right UE close to her body.
AROM: Right wrist extension 25 degrees, wrist flexion 15 degrees, pronation 45 degrees, supine 70 degrees,
radiation and ulnar deviation 5 degrees; Left side WNL.
Strength:
Right
Left
Wrist flexion/extension
2-/5
4-/5
Wrist pronation/supination
2-/5
4-/5
Lower/mid trapezius
2+/5
3+/5
Hip extensors
3/5
3/5
Gluteus medius
3/5
3/5
Lower abdominal strength: Sahrmann Level pre 1A (not able to stabilize with moving hip flexion past 90
degrees, lifting one leg at a time)
Balance/functional measures:
Single leg stance: 10 seconds bilaterally eyes open
Single leg stance: 3 seconds eyes closed
5x sit to stand: 13 seconds
Questions:
1) What are the patient’s identifiable risk factors for Osteoporosis or Osteopenia?
2) What would you want to communicate to the patient’s physician?
3) The patient receives a DEXA scan and the results are:
Lumbar spine: t score -3.21
Right hip: t score -1.78
Left hip: t score -2.62
What is the interpretation of the test results?
4) Are there precautions and/or contraindications for the assessment and treatment of this patient?
5) What additional objective examination tests would be beneficial to perform and why?
6) What patient education would provide related to their bone health?
7) What postural and body mechanics training would you provide to this patient?
8) What exercises do you recommend for this patient in addition to wrist specific rehab and why?
9) Based on the results of the DEXA scan, what exercises would you recommend for improving her bone
strength? For each type of exercise, what frequency and intensity would you recommend for this patient?
10) What is her prognosis? Explain factors that can contribute to better or worse prognosis.