Sample Question

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CASE:

You are evaluating a 66-year-old woman at a health maintenance visit. She had no complaints and no history of chronic illness except postmenopausal osteoporosis, with a bone mineral density greater than 3 standard deviations below the mean. She takes supplemental calcium and is being treated with denosumab IM every 6 months. Her only recent fracture was a compression fracture at T-6, diagnosed 5 months ago. Although she had previously enjoyed tennis, dancing, and gardening, she has drastically reduced her activity for fear of suffering further fractures. She asks if she should resume any sort of regular physical activity. Past medical history is otherwise unremarkable except for anemia, which is now resolved. Vital signs are normal, as is the remainder of the examination.

STEM:

What advice would you give?

ANSWER CHOICES:

  • a. Perform only activities of daily living due to her history of fracture
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  • b. Exercise is contraindicated with osteoporosis.
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  • c. She should work toward resuming her former exercise program.
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    EXPLANATION

    Inadequate physical activity contributes to the development of osteoporosis. Regular weight-bearing and muscle strengthening exercises are recommended to maintain and improve bone strength, as well as to improve agility, strength, and posture and to reduce the risk of falls. Such a regimen may also lead to some increase in bone density. Here, tennis and jogging are weight-bearing activities, to which a muscle strengthening activity such as weight training can be added.

    Activities of daily living alone are inadequate physical activity, which is a contributing factor in the development of osteoporosis. A history of a vertebral compression fracture is not a contraindication to increasing physical activity.

    Exercise is not contraindicated in osteoporosis and is important in its prevention and treatment.

    Both muscle strengthening exercise, such as weight training, and weight-bearing exercises, such as tennis, dancing, walking, and jogging, are recommended for a patient with postmenopausal osteoporosis.

    Treatment with denosumab is not a contraindication to exercise.

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    REFERENCES

    1. Raimundo R: Osteoporosis and physical activity. J Osteopor Phys Act. 2015. 3:139-140.
    2. Cosman F, De Beur SJ, Leboff MS et al.: Clinician’s guide to prevention and treatment of osteoporosis. 2014. Osteoporosis Int. 25:2359-2381.
  • d. She should begin weight training but avoid weight-bearing activities.
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  • e. She should wait to resume exercise until denosumab is discontinued.
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