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Name : Mr. S
Age : 62 years old
Occupation : Ex-Government Employee
Religion : Moslem
Ethnic : Makassar
Marital Status : Married
HISTORY TAKING
Chief complaint : Pain in both of knees
- No fever, no cough
- No nausea and vomiting
- Defecation: normal
- Urination: normal, yellow color.
- No history of DM and hypertension
- No history of long-term corticosteroid intake.
- No history of smoking and alcohol consumption
- No history of trauma. No history of lifting heavy weight.
PHYSICAL EXAMINATION
General Description
General condition : Moderate illness
Nutritional status : 87,7% (normal)
Vital Signs
Consciousness : Compos mentis (GCS 15 E4M6V5)
Blood pressure : 130/80 mmHg
Heart rate : 80 x/ min regular
Respiratory rate : 16 x/min
Temperature : 36,5C (axilla)
VAS : 4/10
PHYSICAL EXAMINATION
Head : Normocephal
Face : Normal
Abdomen
Inspection : Flat
Auscultation : Bowel peristaltic (+) normal
Palpation : No ascites, no organomegaly
Percussion : Tympani
RHEUMATOLOGICAL STATUS
WBC : 10,42
Ur : 16
HGB : 10,1
Cr : 0,65
PLT : 441
GPT :8
X-ray Genu D et S AP/Lat
Osteoarthritis
Osteoporosis senile
Assessment Planning Diagnostic Planning Therapy
Problem List
1. Osteoartritis genu bilateral
Based on :
ESR - Meloxicam 7,5 mg/
Based on patients
condition:
1. 62 years old (>50
years old)
CLASSIFICATION OF
OSTEOPOROSIS
Osteoporosis is divide into 3 Categories: Primary, Secondary, and Idiopathic
Generally patients are asymptomatic present with an episode of acute back pain
even with very low bone densities after bending, lifting, or coughing. It should
Hip Fractures be noted, however, that two thirds of
Acute or chronic back pain secondary vertebral fractures are asymptomatic.
to vertebral fractures
Postmenopausal : dorsal kyphosis or gibbus
Atraumatic or low impact fractures
(Dowagers hump), loss of height,
protuberant abdomen, paravertebral muscle
spasm, thin skin.
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Standard Laboratory Tests
CMP (creatinine, calcium, alkaline phosphatase)
Creatinine: assess for renal function for choice of treatment
Calcium:
if too low consider cause and replete
If too high consider hyperparathyroidism
25-OH Vitamin D
Important to replete if low (low vit D can lead to elevated PTH)
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TREATMENT OPTIONS
Nutritional Recommendations
Calcium ( >51 and older = 1200mg/d)
Vitamin D supplementation for daily intakes (based on obtaining a
serum level of 20 ng/mL). 400-800 IU for those >70 years.
Other nutrients such as salt, high animal protein intakes, and
caffeine may have modest effects on calcium excretion or
absorption. Adequate vitamin K status is required for optimal
carboxylation of osteocalcin
TREATMENT OPTIONS
Pharmacology Recommendation
Bisphosphonates
SERMs (Selective estrogen receptor modulators) raloxifene, tamoxifen, bazedoxifene:
used currently in postmenopausal women
Calcitonin : no longer used
Estrogen: oral estrogens (esterified estrogens : 0.3 mg/d, conjugated equine estrogens :
0.625 mg/d, ethinyl estradiol : 5 g/d) transdermal estrogen, 50 g estradiol per day,
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THANK YOU