[Solved]: B.R. is a 65-year-old woman who has come to the clinic

B.R. is a 65-year-old woman who has come to the clinic with complaints of significant back pain. She has just transferred to your clinic as she was recently widowed and wanted to move closer to her son. In looking at her past medical history, the client has a history of seizures well controlled on phenytoin. As a child she was diagnosed as an asthmatic. She uses a daily inhaled glucocorticoid, a bronchodilator that is used PRN, and oral glucocorticoids that she uses when she has “asthma flare-ups” about four times per year for about 3-6 weeks when symptoms worsen, and she has significant dyspnea at night. At 58, she had a vertebral fracture at T10 when she went to pick up her cat. DEXA scans revealed onset of osteoporosis. BMD scores were -3.33 in the lumbar spine, -2.24 right femoral neck, and -2.44 right radius representing a 6.1%, 6.9%, and 6.2% decrease in expected bone mass. Most recent blood work shows serum calcium at 8.5 mg/dL, Phos 4.6 mg/dL, VitD3 3 ng/mL, PTH 33 pg/mL. Social history is that that the client smokes 4 cigarettes per day (down from 1 (1)/(2) ppd. eight years ago) and drinks one glass of wine per day. Her dietary source of calcium comes from milk with her morning cereal and “some cheese throughout the week.” Her history demonstrates that she reports that she “likes to garden” but does not like to exercise. Since she likes to garden, she uses a SPF 30 sunscreen if she is going outside. List of medications in the medical record: Laboratory Results Table Medication Amount Alendronate 10 mg po QD Calcium carbonate 500 mg po BID Multivitamin tablet po QD Albuterol MDI 2 puffs BID PRN Beclomethasone dipropionate Redihaler 2 puffs BID Phenytoin 100 mg po TID Prednisolone 5 mg po BID PRN As you prepare to meet with this client, describe your concerning assessment findings. What are the risk factors that have predisposed this client to osteoporosis? Using that information, what type of osteoporosis does this client appear to have? What medication(s) would you advocate for this client? Identify teaching points that you will provide to this client including nutrition, maintaining bone health, and other safety factors for this client.