How should this patient be evaluated?
A physical exam was performed, and no abnormalities were noted. Laboratory evaluation revealed a normal chemistry profile with mid-range calcium and phosphate levels, normal thyroid studies and a normal urine calcium level.

A review of the patient's previous medical records revealed that a spine x-ray had been done for persistent back pain about 4 months after her sky-diving accident. The x-ray revealed severe compression fractures at L1 and L2, with radiographic evidence of low BMD or osteopenia at other sites. It is likely that the compression fractures were traumatic and related to the skydiving accident. Radiographic evidence of low BMD is an insensitive finding, and is not diagnostic of osteoporosis. But, once such radiographic evidence of low BMD is found, it should be further evaluated with more definitive testing.