S.P. is admitted to the orthopedic ward. She fell at home and sustained an intracapsular fracture of the
hip at the femoral neck. The following history is obtained from her: She is a 75-year-old widow with three
children living nearby.
Her father died of cancer at age 62; her mother died of heart failure at age 79 . Her
height is 5 ft 3 in; weight is 118 lb. She has a 50–pack-year smoking history and denies alcohol use. She
has severe rheumatoid arthritis (RA) and gastroesophageal reflux disease (GeRd) and had coronary artery
disease with a coronary artery bypass graft 9 months ago. Since then she has engaged in "very mild exer
cises at home." Vital signs (VS) are 128/60, 98, 14, 99° F (37.2° C), Spo2 94% on 2 L oxygen by nasal cannula.
Her oral medications are rabeprazole (Aciphex) 20 mg/day, prednisone (deltasone) 5 mg/day, and meth
otrexate (Rheumatrex) 2.5 mg/wk.
List at least four risk factors for hip fractures.
What will be an ideal response?
• Age (high risk for falls)
• Decreased estrogen (menopause) without estrogen replacement therapy or hormone replacement
therapy
• Smoking
• Lack of exercise
• Corticosteroid therapy
• Antimetabolite therapy
• RA
• Long-term use of proton pump inhibitors for GERD
• Personal or family history of fractures
• Osteoporosis
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