This patient has been on bisphosphonates for 10 years, the referring physician was hoping to give the patient a treatment holiday. 

There was a small improvement in BMD and none of the vertebral fractures demonstrated were new. 

However given the low BMD and history of multiple fractures, the patient’s risk of further fracture remained high. 

A Z-score of -2.0 suggests a possible secondary cause of osteoporosis. Examination of the patient’s risk factors at the time of the scan revealed a history of Crohn disease and previous corticosteroid use. 

The report recommended specialist opinion with regards to a break from therapy.