Welcome to episode 563 of the Divine Intervention Podcasts. My name is Divine. And we're going to

continue our 3137 series. This is going to be part 10. We're going to start with question 92.

A 67 year old woman with osteopenia comes to the office because of a six-month history

of increasingly severe constant pain in her left hip and thigh.

Before her symptoms began, she walked one mile daily.

She now walks with a limp and must use a walker.

Medical history also is remarkable for hypertension.

Medications are hydrochlorothiozide, ibuprofen, and calcium vitamin D supplementation.

Hadexas scan T score was negative 1.8 to one year ago.

Vital signs are within normal limits.

Examination of the left lower extremity produces mild growing tenderness.

Passive range of motion of the left hip is limited by pain.

Serum studies show a calcium concentration of 8.6, intact parathyroid hormone concentration

of 55, that's normal, and 25 hydroxy vitamin D concentration of 30. That's normal. X-rays of the left

hip and femur show cortical thickening of the subtrochanteric region. MRI of the left hip

and femur shows moderate edema of the bone marrow and soft tissue in the subtracteric region. MRI of the left hip and fever shows moderate edema of the bone marrow and soft tissue in the

subtrocantheric region.

There's cortical discontinuity laterally.

Uh-oh.

Which of the following is the most appropriate next step in management?

Right.

So this person, you know, has osteopenia.

...