Tanya is 46 years old and attends her GP because she thinks she has fractured a rib during a coughing fit. She has fractured a rib once before. She has known osteoporosis. This was diagnosed three years ago; she was not perimenopausal at the time and was commenced on a low-dose oral contraceptive pill and has had annual bisphosphonate infusions since. There is no family history of osteoporosis and all investigations have shown no reversible cause. She is noted to have blue sclerae, which she says have been lifelong. Her current T-score is -3.0.
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