A 61-year-old white woman had a dual-energy x-ray absorptiometry (DXA) scan ordered by her primary-care physician. Other than mild essential hypertension, she had no other known medical problems. She fractured her wrist after a fall 3 years earlier. She had lost 2 inches in height since her 30s. After the DXA results were given to her, she started taking Viactiv calcium chews 3 times a day. Her mother may have suffered from osteoporosis. She denied a history of kidney stones, smoking, or excessive alcohol intake.

A grade 2 thoracic kyphosis was detected. The rest of the examination was unremarkable.

A 49-year-old white woman was referred to the clinic because of her recent DXA results. Menopause was at age 40, and the patient was on estrogen replacement therapy (ERT) upon presentation to the clinic. She had taken alendronate for 3 months and Caltrate-D (elemental calcium 1,200 mg/day plus 800 IU vitamin D). Her sister, who is 2 years older, and her mother had osteoporotic fractures. She has not suffered from any fractures, but did report one episode of kidney stones 3 years earlier. She is a smoker (one half a pack per day). There was hyperthyroidism many years ago, but she is euthyroid on her current thyroid hormone replacement.

Physical examination was significant only for a nonpalpable thyroid.

A 50-year-old woman was sent for osteoporosis management. She has no history of fractures or height loss. Menopause was at age 47. The patient is still suffering from menopausal symptoms, including hot flashes and vaginal dryness. She is in good general health, maintains an active lifestyle, and does not smoke. She drinks 2 glasses of skim milk per day and eats a few ounces of cheese.

Physical examination was unremarkable.