Osteoporosis clinical presentation

A 59-year-old woman presents to an urgent care clinic with a 4-day history of frequent and painful urination. She has had fevers, chills, and flank pain for the last 2 days. Her physician advised her to immediately come to the clinic for evaluation. In the clinic she is febrile (38.5°C [101.3°F]) but otherwise stable and states she is not experiencing any nausea or vomiting. Her urine dipstick test is positive for leukocyte esterase. Urinalysis and urine culture are also ordered. Her past medical history is significant for three urinary tract infections in the past year. Each of these episodes was uncomplicated, treated with trimethoprim-sulfamethoxazole, and promptly resolved. She also has osteoporosis for which she takes a daily calcium supplement. The decision is made to treat her with oral antibiotics for a complicated urinary tract infection with close follow-up. Given her history what would be a reasonable empiric antibiotic choice Depending on the antibiotic choice are there potential drug interactions she should be counseled on ... 

The development of bisphosphonates for clinical purposes began with the discovery that inorganic pyrophosphate is present in blood and urine and inhibits the precipitation of calcium and phosphate (1). Derivatives of pyrophosphate had been widely used for industrial purposes, because they inhibit the precipitation of calcium carbonate. Their principal use was as antiscaling additives in washing powders, water, and oil brines, to prevent deposition of calcium carbonate scale. It was then found that pyrophosphate binds strongly to calcium phosphate, prevents both the formation and dissolution of calcium phosphate crystals, and inhibits calcification in vitro. The bisphosphonates are used to treat bone diseases characterized by increased osteoclastic bone resorption (2). Long-term administration of low doses of oral bisphosphonates is considered to be valuable in patients with postmenopausal osteoporosis (3,4). 

Analbuminemia is a rare autosomal recessive disorder. Affected individuals do not exhibit serious clinical symptoms, not even edema. The lack of clinical edema is presumably due to osmotic compensation by the mildly elevated globulins. Osteoporosis in analbuminemia has been corrected by the administeration of human serum albumin. Affected females exhibit minimal pretibial edema, mild anemia, normal liver function tests, absence of proteinuria, lowered blood pressure, elevated serum cholesterol levels, and lipodystrophy. Despite elevated plasma cholesterol levels, severe atherosclerosis was not present. 

Women older than 65 years of age or yonnger with risk factors for osteoporosis shonld have their bone mineral density measured. Although bone densitometry has been shown to predict fractures, at present there are no guidelines for follow-up bone mineral density testing. However, in women with significant bone loss, repeat testing should be performed as clinically indicated. 

Vitamin D supplements are used in diseases of bone and mineral metabolism (eg, intestinal osteodystrophy) that can present with osteomalacia. Older bisphosphonates such as etidronate have only short-term clinical value in osteoporosis or Paget s disease, since their chronic use results in osteomalacia and an increased incidence of bone fractures. The answer is (D). 

Additional SERMs are presently undergoing clinical evaluation for treatment of osteoporosis and menopause-related vaginal atrophy (see Chapter 35). 

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