Case #1: 49-year-female assembly worker at automotive manufacturer presents to your clinic complaining of increasing back pain over the last week. Back pain is in the central low back region and radiates into both gluteal regions – no leg pain. Has been off work for the last 6 months with no improvement in pain.Create a list of possible differential diagnoses?Discuss the evidence that would need to obtain to rule in or rule out each differential?What additional aspects of the history and physical examination could provide relevant information to help in the diagnosis?Case #2: A 65-year-old Caucasian female has a follow-up appointment with a family orthopedist after visiting the emergency department for a wrist fracture. The orthopedist then turns her case over to you to schedule a bone mineral density (BMD) testing. Results of the BMD test show a T-score of -3.0, indicating osteoporosis. Her past medical history includes mild hypertension which is currently managed with propranolol. She also takes a daily multivitamin. She drinks and smokes occasionally and she has no children or spouse.What is the difference between degenerative bone disease and osteoporosis? Explain the pathology of each.What treatment options should be discussed with the patient?What lifestyle changes should be recommended to the patient?
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