Gretchen, a 65-year-old woman, comes into the clinic for follow-up care related to her chronic bronchitis.

Gretchen, a 65-year-old woman, comes into the clinic for follow-up care related to her chronic bronchitis. She has had bronchitis for several years and had an acute episode of respiratory distress 2 months ago. Treatment for the acute respiratory symptoms included the corticosteroid prednisone. She was initially given a high dose of prednisone but was able to tolerate a reduced dose of 10 mg per day since that time. A review of Gretchen’s medical history reveals that she smokes 1 pack of cigarettes a day, a habit she has had for 50 years. She indicates that she is healthy and does not see the need for any other medications. She states that her diet is good, although she has difficulty digesting dairy products and therefore avoids them. She recently experienced low back pain but otherwise has no complaints. Physical examination shows that Gretchen’s body mass index (BMI) is 17; her weight reduced by 5 pounds since her last visit6 weeks before. Her height is 0.5 inches less than the previous visit. Her posture appears to be stooped, and she has difficulty standing up straight. A dual- energy x-ray absorptiometry (DEXA) scan indicates a T score of –2.5 compared with her score of –2.0 12 months before. A radiograph indicates the presence of a vertebral fracture at L3.

1. What is the pathophysiology associated with Gretchen’s clinical presentation?

2. What are the risk factors associated with condition?

3. What clinical manifestations does Gretchen demonstrate?

4. How can Gretchen be diagnosed?

5. What is the treatment for Gretchen?