A 58-year-old African American woman comes for a follow-up visit after sustaining a fracture of the right radius, which occurred when she tripped on loose carpeting and broke her fall with an outstretched hand.
HISTORY
The patient is postmenopausal and was in good health before this incident. She takes a daily multivitamin supplement that contains 400 IU of vitamin [D.sub.2] and 200 mg of calcium. She eats no fish but drinks 1 small glass of milk daily. She has had no other fractures and has no known personal or family history of osteoporosis. She reports minimal physical activity and sunlight exposure. She has had no dual-energy x-ray absorptiometry (DEXA) scans.
PHYSICAL EXAMINATION
The patient's vital signs are normal; body mass index (BMI) is 30. Her right forearm is immobilized in a plaster case. She has no scoliosis.
LABORATORY AND IMAGING RESULTS
Results of a chemistry panel are normal; serum 25-hydroxyvitamin D level is 10 ng/mL. The alkaline phosphatase level is 172 U/L, and the calcium level is 9.1 mg/dL; [gamma]-glutamyl transpeptidase level is 19 U/L. DEXA scanning reveals a T-score of -2 at L1 and a T-score of -1 at the hip.
Which of the following is true?
A. Treating this patient's condition could lessen her risk of several cancers.
B. She will experience maximum clinical benefits from vitamin D supplementation once her serum 25-hydroxyvitamin D level is above 20 ng/mL.
C. Treating this patient's condition will not diminish her risk of future falls and fractures.
D. Her condition can be easily treated with a diet containing plentiful amounts of fresh fruit and vegetables.
E. The patient's current multivitamin supplement contains enough vitamin D to provide maximum health benefits.
CORRECT ANSWER: A
This patient has osteopenia that most likely is associated with vitamin D deficiency. Estimates of the prevalence of vitamin D deficiency among community-dwelling elderly men and women in the United States and Europe range from 40% to 100%. (1,2) Vitamin D is essential to bone health because it plays a critical role in calcium regulation; deficiency contributes to the development and progression of osteoporosis.
Most of the morbidity and mortality associated with osteoporosis results from fractures, particularly fractures of the spine and hip. Between 10% and 20% of persons who sustain a hip fracture die within 1 year, and 50% have permanent functional disability. (3) Vitamin D deficiency in...