Archive for February, 2011
You know that your patient was placed on Calcium Citrate, Vitamin D3 and medication after her first fragility fracture. Now she is back with another fracture. You notice that none of these are on her current med list of what she really takes. Neither are a lot of other meds that her primary provider had prescribed. Why?
Granny Smith has been a delightful patient last 2 years. You enjoyed operating and rehabbing her distal radius fracture 2 years ago. She was so cheerful and hard working getting the use of her shoulder back after her proximal humerus fracture last year. Now it is discouraging to see her so down after her intertroch hip fracture this year. Somehow she never got going with Calcium Citrate or Vitamin D or a DXA or a lateral spine view of her kyphosis or any medication for her Osteoporosis.
The bone was mush. Pinning that hip fracture successfully took all the skill gained in years of surgeries. Sneaking this surgery in before office has made you late (again). Write orders, dictate the report, a quick word with the family, and…….Stop! Tell the family that the bone was mush! Add the diagnoses of Osteoporosis and Fragility Fracture! Treat the whole patient!
The only way to be certain that you do not have a Vitamin D deficiency is to test for 25-hydroxy Vitamin D level. This is a blood test. The test measures 25-hydroxy Vitamin D2, 25-hydroxy Vitamin D3, and Total 25-hydroxy Vitamin D. This test is not yet part of routine blood testing for everyone. It should be done more often.