A 38-year-old Caucasian man recently came to the attention of his physician when he suffered the second of two bone fractures in the past year and a half. He previously was in relatively good health, was not a smoker, and used alcohol only moderately. However, his only form of exercise was cutting the lawn on weekends during the summer months. He has not required any major surgeries during his lifetime, and had only minor bouts of the typical childhood illnesses. However, at age eight he was diagnosed with asthma after he suffered severe respiratory problems during a baseball game on a hot summer day. He has been treated ever since with a daily tablet of a synthetic glucocorticoid and the occasional use of an inhaler when needed to relieve acute symptoms of the disease.
The fractures that the patient experienced were to the left wrist and the right forearm. In both cases, the trauma that caused the fracture was relatively minor. Suspecting that there may be an underlying problem, his physician orders a series of bone density scans. Results of these studies show that the patient has a considerable reduction in bone mass compared with other men of the same age.
1. What is the most probable diagnosis?
2. What is the most probable underlying cause for the patient's problem?
3. What risk factors are present (or absent) in this case?
Answers to Case Study Questions for Chapter 36
1. Osteoporosis and, perhaps, glucocorticoid-induced osteoporosis.
2. Because the patient is young and has a relatively healthy lifestyle, the most probable cause of his osteoporosis is his 30-year history of treatment with glucocorticoids for asthma. Glucocorticoids increase bone loss by inhibiting osteoblasts, stimulating bone resorption, impairing intestinal calcium absorption, increasing urinary calcium loss, inhibiting secretion of sex hormones, and other effects.
3. The patient lacks the risk factors of smoking, excessive alcohol intake, and being female. He does appear, however, to have the risk factor of a somewhat sedentary lifestyle.
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