Leonora, a slightly built 73-year-old woman, visits her long-time family physician complaining of low-grade but constant back pain. The nurse’s examination finds that her weight has remained consistent over time but that she has lost almost 2 inches in height in the past 10 years. Reviewing her chart, the doctor notes that Leonora has been postmenopausal for more than 25 years, declined to take hormone replacement therapy, and broke her ankle 2 years ago after stepping off a curb into the street. Physical examination shows kyphosis (humpback or hunchback). The physician orders a dual-emission X-ray absorptiometry scan to measure bone density but tells Leonora that even without the results of the scan, she is quite sure that the osteopenia most people experience as they get older has, in this case, degenerated into osteoporosis.

1. What is the significance of the fact that Leonora has been postmenopausal for many years?

2. What is the difference between osteopenia and osteoporosis and why does one lead to a reduction in height in patients?

3. Would drug therapy or lifestyle changes work best for Leonora in managing her osteoporosis?