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Bone Case Study
1. A bone mineral density (BMD) test measures the amount of mineral concentration in a specific region of the bones in order to determine a persons bone strength or density and their risk for fractures.
2. The physician uses the BMD test in conjunction with a patient’s history to determine the patient’s risk of Osteoporosis. Osteoporosis is a disease that is characterized by thinning, weak bones. Bone loss is actually a normal event in the human body. We loose bone when cells (osteoclasts) release stored salts (calcium, phosphorous, magnesium) from the bone into the blood stream when dietary intake is not providing adequate amounts. Typically (at least until age 30) we have other cells (osteoblasts) that come in and repair, repair and build lost bone. Osteoporosis occurs when the osteoclasts are working faster than the osteoblasts. Eventually the osteoblasts fall further and further behind leaving thin and brittle bones.
3. Results for the BMD test are given as T-scores and Z-scores. The T-score compares the results with a healthy young adult of the same gender and the Z- score compares it with an individual of the same age and gender. A positive or normal result of the BMD would be 1 standard deviation (+1/-1) of the T-score mean. A result of 2.5 or greater below the mean is considered to be osteoporosis.
4. Osteoporosis is the diagnosis for a person whose score falls 2.5 standard deviations below the mean. If her history reports findings of bone fractures that are osteoporosis related, her diagnosis may be that of severe osteoporosis.
5. When diagnosing a patient the most critical information will come from the patient’s history (familial and personal). This information allows a caregiver to assign specific risk factors associated with certain diseases which help determine a person’s chance of developing a disease as well as measures that can help prevent further progression. It was important for the doctor to know if Janice ‘s diet included adequate amounts of calcium and vitamin D. Both play key roles in bone density, calcium is needed to maintain bone strength and vitamin D is needed for calcium absorption into the blood stream and reabsorbing in the kidneys. Hormone replacement therapy plays a role in the prevention of osteoporosis because it restores estrogen levels and helps to slow the bone thinning process (HRT and its osteoporotic benefits can be offset by possibly increasing risk for other serious diseases).