Osteoporosis Consult

Created by

Julie Roy

Specialty

Rheumatologist

Last edited

10/20/2026

Uses

0 times

Past Medical History

HTN
GERD
Hypothyroidism
Colles' fracture (12/01/2026)

Fracture History

Sustained a right distal radius (Colles') fracture on 12/01/2026 after slipping on ice from a standing height. Managed conservatively with casting for 6 weeks. Denies known clinical vertebral or hip fractures.

Medications

levothyroxine (Synthroid®) 75 mcg PO daily
pantoprazole (Pantoloc®) 40 mg PO daily
amlodipine (Norvasc®) 5 mg PO daily
colecalciferol (vitamin D3) 1,000 IU PO daily

alendronic acid (Fosamax®) 70 mg PO weekly (taken from 2019 to 2021; discontinued due to worsening reflux).

Allergies

Penicillin (rash).

Habits

Caffeine: 2 cups of coffee daily.
Alcohol: 1-2 glasses of wine per week.
Smoking: Ex-smoker (15 pack-years, quit in 2005).

Social History

Retired schoolteacher. Lives in a two-storey home with her husband. Independent with all ADLs and IADLs. Walks 30 minutes 3 times/week, no formal resistance training.

Family History

Mother sustained a hip fracture at age 78. No known family history of vertebral fractures.

History of Presenting Illness

68-year-old female referred following a low-trauma right wrist fracture in January 2026. Recent BMD shows significant decline in bone mass compared to 2021. She reports approximately 3 cm of historical height loss since her twenties, with no acute episodes of severe back pain. No history of falls prior to the recent slip on ice.

Risk factors include maternal hip fracture, prior fragility fracture, chronic PPI use, and remote smoking history. Denies systemic glucocorticoid exposure, malabsorption symptoms, primary hyperparathyroidism, or inflammatory arthritis.

Dietary calcium intake is estimated at 600 mg daily (1 serving of yogurt, milk in coffee, occasional cheese).

Natural menopause at age 49; never used HRT.

Previously trialed alendronic acid (Fosamax®) 70 mg PO weekly for 2 years, stopped in 2021 due to upper GI intolerance. Treatment-naive since then.

Physical Examination

Height: 159.5 cm (peak adult height 163 cm)

Weight: 58.2 kg

Ribbed pelvis distance: 2 fingerbreadths

Occiput-to-wall distance: 0 cm

Investigations

BMD (15/02/2026): Lumbar spine (L1-L4) T-score -2.9, Left femoral neck T-score -2.6, Total hip T-score -2.4. Represents an 8% decline in lumbar spine BMD since 2021.
Labs (10/02/2026): Hb 132 g/L, Cr 68 umol/L (eGFR 78 mL/min), corrected Ca 2.34 mmol/L, PO4 1.12 mmol/L, ALP 74 U/L, Albumin 41 g/L, TSH 2.1 mIU/L, 25-OH Vitamin D 82 nmol/L.

Impression and Plan

68-year-old female with severe postmenopausal osteoporosis (T-score -2.9 and recent wrist fragility fracture). Secondary workup to date is unremarkable. I have ordered a SPEP, serum free light chains, tTG-IgA, PTH, and 24-hour urine calcium to complete the secondary screen.

Given the 3.5 cm historical height loss, I have requisitioned a lateral thoracolumbar spine radiograph to rule out occult vertebral compression fractures.

Given her high fracture risk and history of upper GI intolerance to oral bisphosphonates (plus ongoing PPI therapy), we discussed parenteral options. She prefers denosumab (Prolia®) 60 mg SC every 6 months over intravenous zoledronic acid. We reviewed rare risks including osteonecrosis of the jaw, atypical femoral fractures, and rebound vertebral fractures upon discontinuation. She has a routine dental exam next week and will initiate therapy immediately afterward.

Aim for 1,200 mg of elemental calcium daily through diet and supplementation. Given her dietary intake of ~600 mg and concurrent PPI use, I advised starting calcium citrate (Citracal®) 500 mg PO daily with food, and continuing colecalciferol (vitamin D3) 1,000 IU PO daily.

Repeat BMD on the same densitometer in 2 years (February 2028) to monitor treatment response, with clinical follow-up in my clinic at that time.

CAROC: High risk (> 20% 10-year fracture risk).
FRAX (Canadian): 10-year major osteoporotic fracture risk is 24%; hip fracture risk is 4.8%.

Thank you for sending this referral.

Sincerely,

Dr. Sarah Jenkins, MD, FRCPC Internal Medicine Specialist CPSO #849201

How to use this template

This template can be used to assist with various tasks in the medical field. You can use it to generate notes, manage patient information, or assist with diagnosis and the Assessment and Plan. To use this template, simply click the “Use Template” button above. If you have any questions or need assistance, feel free to reach out to the support team or refer to the description and example output provided above.