The patient is an 81-year-old female weighing only 34.2 kg.
She was hunched over with a prominent dowager's hump suggesting multiple compression fractures in her vertebrae and came to the clinic in a wheelchair.
She was first seen in 2012 with T-scores in the three ROIs.
The spine BMD could not be
interpreted since at least 2 vertebrae between the levels of L1-
4 are needed in order to compute the BMD and T-score. There
were compression fractures in 3 of the relevant lumbar
vertebrae. The initial attending physician started her on an oral
bisphosphonate. The only secondary workups done then was
calcium, a full blood count and vitamin D. They were all
normal. She was already on vitamin D supplementation which
had been provided by another doctor several years back. No
other secondary workup was initiated. Her menopause
occurred in her 50s