Cough-Induced Rib Fractures in a Frequent Tea Drinker

Bruce M. Rothschild, MD

Disclosures

August 11, 2020

Clinical practice guidelines from the American College of Physicians on the prevention of fractures in patients with low bone density or osteoporosis recommends pharmacologic treatment for women with osteoporosis to reduce their risk for hip and vertebral fractures.[12] Alendronate, risedronate, zoledronic acid, or denosumab are indicated. In patients with osteoporotic fractures, an anabolic agent can be considered. Calcitonin, although rarely used may be an alternative based on patient preference. Supplemental calcium and adequate intake of vitamin D3 are also recommended. In postmenopausal women, the American College of Physicians recommends against use of estrogen or estrogen and progestogen or raloxifene.

In this case, the patient's supplemental calcium ingestion was optimized. Her use of aluminum hydroxide and magnesium hydroxide was replaced with calcium carbonate. Bisphosphonates were discussed because they (or anabolic agents) are the option recommended by the guidelines.[12]

The patient was concerned about potential jaw necrosis with dental procedures and requirements for subsequent drug holidays. Biologic agents (eg, denosumab), anabolic agents (eg, abaloparatide), and nasally applied calcitonin were also discussed. The patient opted for calcitonin due to its ease of administration. Although her vitamin D (25-hydroxyvitamin D) level was normal, supplemental vitamin D was recommended.

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