OsteoEd

Practice Cases

Female Hypogonadism

Nancy Simon, MD, MPH Literature reviewed July 31, 2006. Updated May 31, 2009

A 32-year-old woman suffers acute onset of back pain after lifting a heavy tray at work. Her X-ray shows an acute compression fracture at T-7. The patient's chart reveals that she had an eating disorder in her early teens. She currently denies an eating disorder but admits to being "weight conscious." She exercises by running approximately five times/week, 8-10 miles/day. Her last menstrual period was approximately 15 months ago. She has had only three to four periods a year prior to that for many years.

  • Medications:
    • None
  • Physical Exam:
    • 5'4'' tall
    • 105 pounds with resting heart rate 50
  • Point tenderness over T-7 vertebral body

Click an answer under each question.

  1. Does this patient have osteoporosis?

  2. Should this patient be evaluated for secondary osteoporosis?

  3. Which eating disorder is most closely linked with osteoporosis?

  4. What is the most likely cause of her amenorrhea?

  5. What is the mechanism of amenorrhea in anorexia nervosa?

  6. Which of the following is the most effective treatment for reversing bone loss in patients with anorexia nervosa?

Key Points
Last edited July 03, 2009