MEDizzy - A 50-year-old woman presents to your ofce to inquire about

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A 50-year-old woman presents to your ofce to inquire about her risk of fracture related to osteoporosis. She has a positive family history of osteoporosis in her mother, but her mother never experienced any hip or vertebral fractures. The patient herself has also not experienced any fractures. She is white and has a 20-pack-year history of tobacco use, quitting 10 years prior. At the age of 37, she had a total hysterectomy with bilateral salpingo-oophorectomy for endometriosis. She is lactose intolerant and does not consume dairy products. She currently takes calcium carbonate 500 mg daily. Her weight is 115 lb, and her height is 66 in (BMI 18.6 kg/m2). All of the following are risk factors for an osteoporotic fracture in this woman EXCEPT:

ExplanationThere are multiple risks for osteoporotic bone fractures that can be either modifable or nonmodifable. Nonmodifable risk factors include a previous history of fracture as an adult, female sex, white race, dementia, advanced age, and history of fracture (but not osteoporosis) in a frst-degree relative. Risk factors that are potentially modifable include low calcium intake, alcoholism, impaired eyesight, recurrent falls, inadequate physical activity, poor health, and estrogen defciency, including menopause prior to age 45 or prolonged premenstrual amenorrhea. Excessive thinness and low body weight are also risk factors for osteoporosis, although the osteoporosis guidelines do not clearly delineate what is considered excessive thinness. Current cigarette smoking is a risk factor for osteoporosis-related fracture, whereas a prior history of cigarette use is not.