This is a medically complex, frail, elderly woman with psychosocial issues in addition to her chronic illnesses. Her osteoporosis is only part of her clinical picture here but becomes more important over the next several months.
Below is a list of her medications from July 2003. Medications that are particularly relevant to her osteoporosis are highlighted in red. Of note, the calciuric effect of furosemide may affect whole-body calcium balance, and thyroid hormone treatment can increase bone loss even in the absence of subclinical hyperthyroidism.
Over these few months, the patient suffered repeated hospitalization and functional decline with a corresponding decrease in her overall sense of satisfaction with her life.
She was able to stay out of the hospital for a few months, but continued to have poor functional status and the above medical issues compromising her quality of life.
The week of Thanksgiving marked the beginning of an important change in her living situation. Initially, her goals of care centered on returning home to live independently.
November 2003 – January 2004
January 2004-December 2004
Discussion and Summary
Criteria include the following:
Several case series and a few prospective but uncontrolled clinical studies support vertebroplasty as a safe and effective treatment for osteoporotic compression fractures. Significant and nearly immediate pain relief is obtained in about 90% of patients, and lasts up to 18 months. Measures of quality of life improve within 2 weeks and remain improved for up to 6 months.
Importantly, minimally invasive spinal surgery was considered as a possible means of relieving her pain and improving her quality of life, although the decision was made to proceed with even less invasive intervention because of her pulmonary and cardiac status.
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