A 55-year-old woman comes to the office for a periodic health maintenance examination. She has been a patient for a number of years but you have not seen her for five years. Her review of systems is positive for fatigue, recent weight gain, temperature intolerance with hot flashes being frequent, and some mild pruritus over her hands. Her last menstrual period was seven months prior. She had a cholecystectomy at age 43 and an ovarian cyst removal at age 23. Her family history is remarkable for a father who died of a myocardial infarction at age 59 and a mother who is alive and well. Her sister and her aunt both died of breast cancer at age 61. Her father and her grandfather both had diabetes. She smokes one-half pack of cigarettes per day. She appears her stated age, is well and in no distress. Her temperature is 37.0 C (98.6 F), blood pressure is 110/80 mm Hg, and pulse is 65/min. Physical examination is unremarkable. Concerning her post-menopausal status, the most appropriate intervention to reduce long-term morbidity and mortality is
A. annual bone density surveys
B. estrogen and progesterone replacement
C. estrogen and progesterone replacement and bisphosphonate therapy
D. estrogen replacement and bisphosphonate therapy
E. estrogen replacement only
|