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Rheumatologist

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Real-Life Communication

You're a rheumatologist. You are seeing a patient who fractured her hip during a slip on her icy sidewalk. It's the second time she has broken a bone due to a fall. Because of this, you recommend bone density testing.

"You have to have good social skills to do this work," says Dr. Susan Barr. She is a rheumatologist. "You do many exams on people and can develop long-term relationships with the patients."

You explain to the patient that you're concerned about her falls. You want to test her for a condition called osteoporosis. She says that she knows nothing of the disease. This is what you tell her:

Osteoporosis is a disease that affects the bones. The bones lose density and become fragile and break. If this condition is left untreated, bone fractures can result. The most common bones affected are the hip, spine and wrist.

It's important to know about osteoporosis because it can be prevented. There are four ways to prevent this disease. The first way is to eat a diet rich in calcium and vitamin D. It's recommended that, depending on age, a person consume between 1,000 and 1,300 mg per day of calcium.

It's just as important to get enough vitamin D, which aids in calcium absorption. Vitamin D can be absorbed through the skin when in contact with sunlight, and can be found in some fortified foods. A person needs an average of 400 to 800 IU of vitamin D per day.

Second, weight-bearing exercise is necessary to keep up bone density.

Third, a person should lead a healthy lifestyle. That means limiting alcohol intake and not smoking.

Lastly, bone density testing can catch osteoporosis early. Some medications can be used to prevent and treat the disease. Estrogen replacement or hormone replacement therapy, alendronate, raloxifene and risedronate can all be used to prevent osteoporosis.

The patient nods her head. She agrees that she wants her bone density to be tested. But first she has some questions:

  1. Which bones are most likely affected by osteoporosis?
  2. How many milligrams of calcium should a person get each day?
  3. Why is it important to get enough vitamin D?
  4. What medications can be prescribed to prevent osteoporosis?

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