After the maximal bone mass is attained at the age 30, the rate of bone loss for both gender is approximately 0.5% per year, and it increase to approximately 1% per year or more in menopausal women. This is so because, estrogen acts indirectly to suppress bone re-sorption, an action reduced/absent during menopause. Poor nutrition or an age-related decrease in intestinal absorption of calcium because of deficient activation of vitamin D is a culprit of the prevalence of Osteoporosis among elderly. "In the United States, 10 million people already have osteoporosis. Millions more have low bone mass, or osteopenia, placing them at increased risk for more serious bone loss and subsequent fractures"."Hip fractures are common and are often devastating in the geriatric population". Other risk factors found to be associated with this disease include, smoking, alcohol ingestion and genetic predisposition. As with the case at hand patient Hunt manifested almost all of the indicated risk factors, having had hysterectomy at the age 45 inducing early menopause, smoking and alcohol consumption and most of all, a history of calcium and Vitamin D deficiency as evidenced by Rickets disease in her childhood.
Weight-bearing exercises like jogging, walking, rowing and weight lifting are important in maintaining bone mass. "Studies have indicated that pre-menopausal women need more than 1000mg and post-menopausal women needs 1500mg of calcium daily" (Andrews. 1998). This means that adults should drink 3 to 4 glasses of milk daily or substitute other foods that are high in calcium (Bukata & Rosier. 2000). Calcium supplements and a daily intake of 400-800 IU of Vitamin D is recommended because the latter optimizes calcium absorption and inhibits parathyroid secretion, stimulating calcium re-sorption from the bone (Weinstein & Ullery. 2000). Estrogen Therapy is the single most powerful intervention to reduce the incidence and progression of osteoporosis. If commenced immediately after menopause prevents early-stage bone loss and provides beneficial effects if administered throughout the eight decade of women's years (Gambert Et. Al. 1995). Women with breast cancer, active liver disease, a history of blood clots, or unexplained vaginal bleeding should, under no circumstance, go on HRT (Cooper). Additionally women who have migraine headaches, high triglycerides, gallbladder or chronic liver disease, a history of cancer of the uterus or ovaries, fibroids, history of endometriosis, or a history of exposure to the estrogen DES should go under careful evaluation before even considering HRT (Hueseman, 2002). Active treatment of osteoporosis uses four types of agents; gonadal hormones (estrogen), calcitonin, fluorides and biphosphonates. Calcitonin can be used to decrease osteoclastic activity. Although the risk of endometrial cancer is increased with hormone therapy, risk is reduced with subsequent administration of progestin (Riggs & Melton. 1992). In the cases where fracture is involved, management includes immobilization, pain medication, early ambulation and wound care. Surgical intervention is done for stable fracture fixation that allows early restoration of mobility and functions; this means early weight bearing. Walking and