••• CHAPTER 33^ Menopause^327
❍ How soon after treatment is started should a repeat DXA be done?
1 to 2 years. The sensitivity of DXA is such that it would take this long to see a meaningful change. One exception
is a patient on steroids. In this situation, the DXA can be done as early as 6 months.
❍ What change would you expect to see after 1 to 2 years of treatment?
The DXA should show stabilization or improvement in BMD.
❍ What if there is a significant loss (>4–5%) at 2 years?
Check the Z score. If it is lower than expected, evaluate for secondary causes of osteoporosis.
❍ What logical steps can be suggested to a patient to prevent falls?
Safeguard the home by removing electrical wires from the floor.
Remove throw rugs.
Improve lighting.
Evaluate the patient’s vision.
Treat urinary incontinence—fewer nighttime awakenings and decrease urine leakage onto floor.
❍ Can smoking one pack per day throughout adulthood reduce bone density by as much as 10% by
menopause?
Yes.
❍ What percentage of patients with hip fractures have histological evidence of osteomalacia, the classic
manifestation of vitamin D deficiency?
30%.
❍ What is the largest source of dietary vitamin D?
Milk.
GENITOURINARY CHANGES
❍ What genitourinary tissues are estrogen sensitive?
The vagina, vulva, urethra, and trigone of the bladder.
❍ What vaginal symptoms are related to atrophy?
Dryness, dyspareunia, and recurrent atrophic vaginitis.
❍ What causes dyspareunia in aging women?
Decreased vaginal lubrication and elasticity.
❍ Is vaginal estrogen therapy more effective than moisturizers and lubricants?
Yes.