Which client is at greatest risk for osteoporosis?

Choice A reason: Inflammation and hematoma formation occur immediately after a fracture, initiating healing by recruiting immune cells and growth factors. However, this stage does not restore ‘normal’ bone structure, as it involves soft tissue response, not bone remodeling. This statement is inaccurate, as the bone remains structurally abnormal during this early phase.

Choice B reason: Callus formation, occurring 2-6 weeks post-fracture, involves soft and hard callus bridging the fracture. While critical, it represents a temporary, weaker structure, not ‘normal’ bone. Osteoblasts form a cartilaginous matrix, but full strength and normal bone architecture require further remodeling, making this statement less accurate.

Choice C reason: Woven bone formation, where osteoblasts convert callus into disorganized woven bone, marks progression toward normal bone structure. This bone is later remodeled by osteoclasts and osteoblasts into lamellar bone, restoring strength and architecture. This statement is accurate, as woven bone formation approaches ‘normal’ bone structure during healing.

Choice D reason: Osteoclast proliferation resorbs bone during remodeling but does not directly restore ‘normal’ bone. Excessive osteoclast activity could weaken the bone. Osteoblasts, not osteoclasts, drive the formation of woven and lamellar bone, making this statement inaccurate, as osteoclasts support remodeling, not normalization, of bone structure.

Choice A reason: A 30-year-old male with occasional alcohol use and normal BMI (25) has minimal osteoporosis risk. Alcohol in moderation and normal weight do not significantly reduce bone density. Peak bone mass is typically preserved at this age, making him less at risk compared to glucocorticoid users.

Choice B reason: A 22-year-old female post-pregnancy may experience temporary bone density loss due to calcium demands during pregnancy and lactation, but young age and ongoing bone remodeling reduce long-term osteoporosis risk. Recovery is likely with adequate nutrition, making her less at risk than the glucocorticoid-treated patient.

Choice C reason: Glucocorticoids, used for inflammatory bowel disease, significantly increase osteoporosis risk by inhibiting osteoblast activity, reducing calcium absorption, and increasing bone resorption. This 40-year-old male faces accelerated bone loss, especially with chronic use, making him the highest risk among the options due to medication-induced bone density reduction.

Choice D reason: A 35-year-old female running marathons engages in weight-bearing exercise, which promotes bone density through mechanical stress and osteoblast stimulation. This reduces osteoporosis risk compared to glucocorticoid use, as exercise enhances bone remodeling and strength, making her less likely to develop osteoporosis than the male on steroids.