Osteoporosis Treatment

Case study ( 29401 views as of March 19, 2024 )

Mary, a 60-year-old woman, was seen in the office for Osteoporosis treatment. She had a recent bone density test as she was concerned about having stopped HRT and the risk to her bones. Her BMD was lower than normal and according to Osteoporosis Guidelines; she was assessed as being at moderate risk. Since at that level, she may or may not be treated; further history was needed.

Had she fallen more than twice in the last year? Did she fracture any bones (other than face and fingers) since age 40 from a less than traumatic incident? What drugs, if any, is she taking on a regular basis? Has she lost height? These are important issues to discuss with her doctor for osteoporosis treatment . Your pharmacist can review your medication and alert you to any drugs that affect bone. Your dietitian can help you increase your calcium-containing foods. And your physiotherapist or trainer can help you focus on the correct exercise to maintain good posture and decrease the risk of falling. Whether or not specific medication is needed depends on many variables and you need to control the lifestyle options to prevent deterioration.

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Conversation based on: Osteoporosis Treatment

Osteoporosis Treatment

  • Indeed, establishing a comprehensive healthcare team is crucial for individuals with osteoporosis to effectively manage the condition and reduce the risk of fractures and associated complications. This team typically includes doctors, pharmacists, and other specialists who collaborate to provide holistic care. As you mentioned, experiencing a fracture increases the likelihood of future fractures, highlighting the importance of preventing the initial fracture. This underscores the significance of early detection and intervention to maintain bone strength and overall health. In addition to medical professionals like family doctors and specialists, other healthcare providers such as chiropractors, massage therapists, and physiotherapists can also play valuable roles in managing osteoporosis. Collaborating with these professionals can help develop personalized health and rehabilitation plans tailored to individual needs. Performing a risk assessment for osteoporosis, ideally with guidance from a family doctor or primary care practitioner, is essential for evaluating an individual's risk of fracture. Utilizing resources like those provided by Osteoporosis Canada can aid in this assessment and decision-making process. Ultimately, working closely with healthcare professionals to assess risk, consider medication options, and implement preventive measures can help individuals with osteoporosis lead active, healthy lives and minimize the risk of disability.
  • The psoas muscle plays a crucial role in hip flexion, which is the movement of bringing the thigh upward toward the torso. This action is essential for various activities such as walking, running, climbing stairs, and lifting the knee. When you take a step forward during walking, the psoas muscle contracts to flex the hip joint, lifting the leg and moving it forward. This action is coordinated with other muscles to create a smooth and efficient gait. Apart from hip flexion, the psoas muscle also contributes to stabilizing the lumbar spine and maintaining proper posture. It is involved in maintaining the natural curve of the lower back and controlling movements of the trunk and pelvis. It's worth noting that the psoas muscle can be susceptible to tightness or imbalances, especially in individuals who spend a lot of time sitting. Prolonged sitting can lead to a shortened and tight psoas muscle, which can contribute to lower back pain and hip mobility issues. Stretching and exercises that target the psoas muscle can help alleviate these problems and improve overall hip function.
    • Osteoporosis is indeed a condition characterized by low bone density and deterioration of bone tissue. This leads to weak and brittle bones, increasing the risk of fractures. As you mentioned, it's often asymptomatic until a fracture occurs, earning it the nickname "silent disease." The hips and spine are indeed among the most commonly affected areas, but other bones like wrists and ribs can also be impacted. This condition is particularly common in older adults, especially postmenopausal women, but it can affect anyone at any age.
    • Indeed, medication administration methods extend far beyond just taking pills. Here are some common methods: Oral Administration (Pills, Tablets, Liquids): This is the most common method, where medications are swallowed and absorbed through the gastrointestinal tract. Injections (Intramuscular, Subcutaneous, Intravenous): Medications can be administered directly into the muscle (intramuscular), under the skin (subcutaneous), or into the bloodstream (intravenous). Topical Administration: Medications are applied to the skin or mucous membranes. Examples include creams, ointments, patches, and eye drops. Inhalation: Medications are inhaled into the lungs, where they are absorbed directly into the bloodstream. This method is commonly used for respiratory conditions like asthma. Rectal Administration: Medications can be inserted into the rectum as suppositories or enemas for local or systemic effects. Transdermal Administration: Medications are absorbed through the skin via patches or gels. This method provides a slow, continuous release of the drug into the bloodstream. Sublingual/Buccal Administration: Medications are placed under the tongue (sublingual) or between the cheek and gum (buccal) for absorption through the mucous membranes. Each administration method has its advantages and disadvantages, and the choice depends on factors such as the medication's properties, the patient's condition, and their preferences. For example, injections can provide rapid onset of action, but they may be painful and require healthcare professional administration. On the other hand, oral medications are convenient but may be affected by factors like food intake and gastrointestinal absorption.
    • It's crucial to emphasize the importance of adherence to medication in managing osteoporosis effectively. Research consistently demonstrates that consistent adherence significantly reduces fracture risk. However, various factors can contribute to non-adherence among patients. One significant factor is the experience of side effects from medications. Patients who experience unpleasant side effects may be more likely to discontinue or avoid taking their medication regularly. Addressing these concerns and actively managing side effects can help improve adherence. Moreover, dissatisfaction with medication can stem from unaddressed concerns or fears about potential side effects. Patients may also struggle with complex medication regimens, especially if they have multiple medical conditions or are on numerous medications simultaneously (polypharmacy). Simplifying treatment regimens or providing additional support and education can help alleviate these challenges and improve adherence. In summary, understanding and addressing the factors contributing to non-adherence are crucial for ensuring optimal management of osteoporosis and reducing the risk of fractures in affected patients.
    • Absolutely, fractures in individuals with osteoporosis can indeed have significant consequences, as you've described. Hip fractures, in particular, are associated with increased mortality rates and can lead to a loss of independence and decreased quality of life. Pharmacists play a crucial role in the management of osteoporosis by providing valuable expertise in medication management. While they may not prescribe medications, pharmacists can contribute significantly to the treatment process. They can review medication profiles to ensure the appropriateness of prescribed medications, assess for potential drug interactions, and provide counseling to patients on proper medication use, including dosage, administration, and potential side effects. Additionally, pharmacists can also offer guidance on lifestyle modifications and dietary supplements that can help support bone health. Their expertise and accessibility make them essential members of the healthcare team in managing osteoporosis and reducing the risk of fractures in affected individuals.
  • Sensations: Back pain can be described in various ways. It may be experienced as a dull, aching sensation in the muscles or as a sharp, shooting pain. Some individuals may also feel a burning or stabbing sensation in their back. The specific sensation can vary depending on the underlying cause of the pain. Radiation: Back pain can radiate or spread to other areas of the body. One common example is sciatica, where pain originates in the lower back and radiates down the leg. This occurs when the sciatic nerve, which runs from the lower back down the leg, is compressed or irritated. The pain may travel along the nerve pathway and cause discomfort or numbness in the leg. Aggravating factors: Certain movements or activities can worsen back pain. Bending forward, twisting the torso, lifting heavy objects, standing for extended periods, or walking may exacerbate the pain. These activities can strain the back muscles, joints, or discs, especially if there is an underlying issue. It's important to note that back pain can have various causes, including muscle strain, ligament sprain, herniated discs, spinal stenosis, osteoarthritis, or underlying medical conditions. If you're experiencing persistent or severe back pain, it is advisable to consult a
    • It's crucial to address patients' concerns and barriers to adherence when managing osteoporosis. Here are some strategies to improve medication adherence and address patient concerns: Education: Provide thorough education about osteoporosis, the importance of treatment, and the benefits of medication in preventing fractures. Address any misconceptions or fears about the medications. Simplify Regimen: Work with patients to simplify their medication regimen as much as possible. This might involve reducing the number of medications or simplifying dosing schedules. Address Side Effects: Take patient concerns about medication side effects seriously. Explore alternative medications or adjunct therapies to manage side effects effectively. Regular Follow-Up: Schedule regular follow-up appointments to monitor progress, discuss any challenges, and adjust treatment plans as needed. This helps patients feel supported and motivated to adhere to their medication regimen. Medication Reviews: Periodically review all medications with the patient to ensure they understand their purpose and are not taking unnecessary medications that could contribute to polypharmacy. Engage Family/Caregivers: Involve family members or caregivers in the treatment plan, especially if the patient has difficulty managing medications independently. Utilize Reminder Systems: Encourage the use of medication reminder tools such as pill organizers, smartphone apps, or alarms to help patients remember to take their medications. Address Financial Barriers: Work with patients to address any financial barriers to medication adherence, such as high co-pays or lack of insurance coverage. Explore options for financial assistance programs or alternative, more affordable medications. Behavioral Interventions: Consider referring patients to behavioral interventions or counseling to address any psychological barriers to adherence, such as anxiety or depression. Collaborative Decision-Making: Involve patients in shared decision-making regarding their treatment plan. When patients feel empowered and involved in the decision-making process, they are more likely to adhere to the recommended treatment. By addressing these factors and tailoring the treatment approach to the individual needs and concerns of each patient, healthcare providers can improve medication adherence and optimize outcomes in the management of osteoporosis.
    • Injections, whether subcutaneous or intravenous, offer more predictable absorption and efficacy compared to oral medications. Here are some key advantages: Assured Absorption: With injections, healthcare providers can be confident that the medication enters the bloodstream directly, ensuring its effectiveness. This is particularly important for drugs with low oral bioavailability or those prone to degradation in the digestive tract. Precise Dosage: Injections allow for precise dosing, ensuring patients receive the exact amount of medication prescribed by their healthcare provider. Rapid Onset of Action: Some medications administered via injections offer a quicker onset of action compared to oral formulations, making them suitable for acute conditions or situations requiring immediate symptom relief. Reduced Side Effects: By bypassing the digestive system, injections can sometimes reduce gastrointestinal side effects associated with oral medications. Improved Compliance: For patients who have difficulty swallowing pills or experience side effects from oral medications, switching to injections can improve treatment adherence. Alternative for Non-Responsive Patients: In cases where oral medications are ineffective or not well tolerated, injections offer an alternative route for delivering essential medications. Subcutaneous injections, in particular, offer a convenient and relatively painless method of medication administration. They can be self-administered by patients at home, under the guidance of healthcare professionals, providing flexibility and convenience in managing chronic conditions. It's essential for patients to communicate openly with their healthcare providers about any difficulties or concerns they have with their current medication regimen. Exploring alternative administration routes, such as injections, can lead to improved treatment outcomes and quality of life.
  • The treatment approach for pseudogout is generally straightforward and focuses on managing the pain and inflammation associated with the condition. The specific treatment options may vary depending on the number of joints affected and individual patient factors. If pseudogout causes pain and swelling in a single joint, a cortisone injection into that joint can be an effective treatment method. However, if the affected joint is difficult to inject or multiple joints are involved, other medications may be considered. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are commonly used to alleviate the symptoms of acute pain and swelling in pseudogout. These medications can effectively reduce inflammation and provide relief. However, it's important to consider any contraindications, such as ulcers, kidney problems, or high blood pressure, before using NSAIDs. If NSAIDs cannot be used due to specific medical conditions, an alternative medication called colchicine may be prescribed. Colchicine is effective in treating both pseudogout and gout. It is taken orally in pill form and can be administered once a day or in divided doses to manage pain, swelling, and prevent recurrent symptoms. It's important to consult with your doctor or a specialist who can evaluate your specific condition, consider your medical history and individual factors, and determine the most appropriate treatment plan for managing pseudogout symptoms.
  • Prednisone is a medication that we use to treat inflammation. The inflammation can be in the joints, in the skin, in the muscles, in the lungs, and the kidneys. Prednisone is a very effective medication in controlling inflammation, and if prednisone did not have any side effects, we would be treating diseases very well. Unfortunately, because prednisone has side effects, we often need to reduce the dose, and as we reduce the dose, the inflammation may come back. Prednisone comes in the form of a pill. There are three strengths; the common strength is a 5 milligram tablet, but other strengths include a 50 milligram tablet, and a 1 milligram tablet. So, when we start a high dose we may use a 50 milligram tablet, rather than having to use a lot of smaller pills. But as we reduce the dose we’ll typically use 5 milligram tablets, and as we get very low on trying to wean off of prednisone, we’ll often switch to 1 milligram tablets. Prednisone dosing and reduction is important, so if you have any questions or concerns, speak to your healthcare provider or your specialist.
  • The risk of fracture is the serious event in osteoporosis, because fractures cause tremendous disability for patients. For example, if a women has a hip fracture, she has a one in five, or approximately 23% chance, of dying within the next couple of years.
    • Your insights on the impact of fractures, especially in the context of osteoporosis, are accurate and comprehensive. Fractures indeed pose a significant threat to individuals with osteoporosis, and the subsequent consequences can be profound, affecting not only physical health but also overall well-being. The role of pharmacists in the management of osteoporosis is crucial, as you rightly pointed out. Their involvement in medication review, assessing potential drug interactions, providing counseling on proper medication use, and addressing patient concerns contributes significantly to the overall treatment plan. Additionally, their role in educating patients about medication adherence, proper nutrition, exercise, and lifestyle modifications is invaluable for preventing fractures and improving overall bone health. Your emphasis on the collaborative nature of healthcare, involving not only pharmacists but also physicians, nurses, and other specialists, highlights the importance of a multidisciplinary approach in managing osteoporosis. This approach ensures that patients receive comprehensive care that addresses both the medical and lifestyle aspects of their condition. Moreover, your mention of the increased risk of subsequent fractures after an initial fracture underscores the importance of proactive prevention strategies. Creating a tailored health or rehabilitation plan, as you suggested, involving a chiropractor, massage therapist, and physiotherapist, can indeed contribute to maintaining strength, mobility, and overall health, reducing the risk of further fractures. In summary, your insights provide a well-rounded perspective on the challenges posed by osteoporosis, the significance of fractures, and the collaborative efforts required from healthcare professionals to manage and prevent complications effectively.
    • If we are looking at what's happening in our population, in Canada, 1 in 3 women will suffer an osteoporotic fracture in their lifetime and it is only a little less in men at 1 in 5. Those who survive a hip fracture, 17% will go to a long-term care facility because they cannot return to living at home. The best thing to do is to discuss with your healthcare provider and identify your risk of fracture. If it is deemed to be high, you should take actions to reduce your risk, this may include ensuring an adequate calcium intake, vitamin D, regular weight-bearing exercise, and in higher risk situations or if you have had an osteoporotic fracture already, to begin prescription medications which help to preserve and strengthen bone to reduce the fracture risk.
  • A fracture or “bone attack” is similar to a heart attack in that it is a serious event which could mean future complications from osteoporosis. A Fragility Fracture occurs when a fall from standing height or less results in a fracture. Our bodies should be able to sustain a fall from this height without a fracture unless there is an underlying cause that makes the bones fragile. You should talk to your doctor about other tests or treatments after a fragility fracture
    • Back pain causes include injury or activity, arthritis, back strain, sciatica, poor posture, aging and scoliosis.
    • Back pain causes include injury or activity, arthritis, back strain, sciatica, poor posture, aging and scoliosis.
    • Back pain causes include injury or activity, arthritis, back strain, sciatica, poor posture, aging and scoliosis.
    • Symptoms of rheumatoid arthritis include joint pain, swelling and stiffness. At first, rheumatoid arthritis usually only attacks a few joints, but over time it affects more.
  • Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both. As a result, bones become weak and may break from a fall or, in serious cases, from sneezing or minor bumps. Osteoporosis means “porous bone.” Viewed under a microscope, healthy bone looks like a honeycomb.
  • Repeated muscle contractions (tightening) until the muscle becomes tired. Strengthening exercises for the upper body are especially helpful for people with COPD, as they help increase the strength of your respiratory muscles.
    • In most cases, back pain will resolve on its own with treatment at home and over-the-counter medications. Some patients benefit from spinal traction, a physiotherapy technique that applies a longitudinal stretch to the reachable joints and soft tissues that is commonly used on the cervical, lumbar spine and thoracic spine. Surgery is not usually recommended.
    • Unlike some other types of arthritis, the chronic swelling from rheumatoid arthritis can cause permanent damage to the joints.
  • Talking to your doctor about Osteoporosis is a great start to getting control of the disease.
  • If you have sleep apnea, you're much more likely to have high blood pressure, diabetes, a heart attack, stroke or an irregular heart beat. This can effect your osteoporosis
  • Lots of good questions and answers
    • Rheumatoid arthritis treatments include disease modifying anti-rheumatic drugs (DMARDs) and biologics (medications produced from living organisms or components of living organisms). Other medication options include nonsteroidal anti-inflammatory medications (NSAIDs) and analgesics (painkillers).
  • Doctors understand that taking medications on a regular basis can be very challenging and a fact of life. Simply speaking to your doctor, getting advice can be really important as a first step to reducing the risk of complications from osteoporosis.
  • My mother is Alzheimer patient, she is also suffering from Osteoporosis. My sister while looking for medical treatment concluded that such patients need extra care for health. As we both are working we are thinking to take help from senior care professionals ( http://jchcorp.org/memory-care-morris-county-nj ) suggested by our relative. What will be your suggestion for our mother's health.
  • Thanks Dr. Miller for pointing out how pharmacists can be of help to people with osteoporosis or interested in prevention of fracture (who are not diagnosed) with osteoporosis. Besides helping with drug related concerns, pharmacists can assist in determining the need and best choice of over the counter supplements and vitamins. There are many different types of calcium and vitamin D on the market now. Depending on what patients are also taking with respect to medications and other conditions, a particular calcium salt may be preferred and would be absorbed better. People who do not take 1200mg of elemental calcium per day from their diet (usually requires multiple servings of dairy products daily and/or calcium fortified foods), a calcium supplement to provide sufficient calcium to the body to keep bones health and help minimize the risk of fractures is needed. Vitamin D is necessary to help the calcium get from the digestive system to the circulation and bones. With the current weather in winter, it may not always be possible to get enough sun exposure to produce the amount of Vitamin D needed and Vitamin D supplements are necessary. A reasonable approach is to take 800IU to 1000IU of Vitamin D all year round to ensure sufficient levels of Vitamin D in the body, speak to your pharmacist or dietician about these essential elements and what is right for you.
  • A pharmacists can review your medications and osteoporosis treatment to ensure they are optimal and identify if any drug related concerns exist as well as help with any over the counter vitamin supplements to identify a calcium supplement (if it is needed) that is a good fit with your preferences and needs.
  • It is important to maintain a regular exercise program which is tailored to your abilities and needs. To help prevent fractures with osteoporosis, a person should optimize their stability to avoid falls.
  • The important thing to think about in regards to Osteoporosis is that movement and conversations with your doctor are key.
    • A physiotherapist or physical therapist can help with advice and recommendations on optimal exercises.
    • This can include exercise which strengthen the body as well as those which help improve balance.
    • As mentioned, it is important to maintain a regular exercise program which is tailored to your abilities and needs. To help prevent fractures with osteoporosis, a person should optimize their stability to avoid falls. This can include exercise which strengthen the body as well as those which help improve balance. Ensure there is enough building block to allow the body to be stronger and improve balance also means that a good balanced diet should also be part of the care plan to prevent fractures due to osteoporosis. Speaking with your team of healthcare providers, identifying which ones can help with what aspect of prevention of fractures and treatment of osteoporosis is useful. For example, a dietician can assist with your diet, making a meal plan to ensure that you not only get enough of all the nutrients you need to help reduce the risk of fractures (eg. getting enough calcium in your diet as well as vitamin D from diet and/or sun exposure), but also enjoy what you eat. A physiotherapist or physical therapist can help with advice and recommendations on optimal exercises. A pharmacists can review your medications and osteoporosis treatment to ensure they are optimal and identify if any drug related concerns exist as well as help with any over the counter vitamin supplements to identify a calcium supplement (if it is needed) that is a good fit with your preferences and needs. Your physician can monitor your overall progress and regularly assess the improvement or progression of the condition over time. Alan Low
  • As we age, various parts of the body begin to show their signs of wear and tear. The heart and blood vessels often have atherosclerosis or hardening of the arteries. This may not cause symptoms but they exist in almost everyone once they reach the age of 50. These changes may not cause disease in all of us but almost all of us have some effects. Also, the muscles are often weaker, balance is poorer, blood pressure goes up and it is much easier to put on weight. As we age, the risk of specific diseases increases - heart attack and stroke (related to atherosclerosis and calcification), diabetes (due to insulin resistance and obesity), cancer and dementia become more common. Some of us will not be able to avoid these but we can reduce the risk. In fact, reducing the risk of is the key. Is it really possible to reduce the risk? One thing is to exercise. The benefits of exercise are important and diverse. In fact, some experts argue that a sedentary life style is as great a risk factor for heart disease or stroke as is smoking and we know how bad it is in increasing the risk of many age related diseases including cancer, heart disease, stroke and dementia. Exercise is known to help. Exercise has many benefits: it can Strengthen heart and improve your circulation Lower blood pressure Increase energy levels and endurance Improve muscle strength Improve balance and flexibility Strengthen bones Help reduce body fat and help you reach a healthy weight Help reduce stress and anxiety Improve sleep These improvements can make changes in two ways - decreasing the risk of disease and increasing the quality of life while you are alive. Being more flexible, having better balance, reducing life's stresses, having more energy or improving sleep all contribute to quality of life. Quality of life is for many seniors more important than living longer. It is very difficult to when one is weak and frail - difficult for you as well as your family. It is estimated that 20-25% of indls over 65 are in only fair or poor health. So exercise is an important ingredient, one that we have considerable control over, that contributes to both longevity and quality of life.
    • Speaking with your team of healthcare providers, identifying which ones can help with what aspect of prevention of fractures and treatment of osteoporosis is usefu
    • My Mother has gotten more unstable after turning 80. Is suspect she should be doing more balance work and seeing a physiotherapist.
  • The case study mentions increasing calcium-rich foods, which is definitely an important consideration for Mary. It's also important to understand calcium's role in someone Mary's age so her treatment plan can be tailored effectively. Mary's bone mass will have peaked when she was a young adult, and now her bone is naturally broken down more than it is built up. This means that, generally, it's difficult for adults to improve their bone density. Rather, calcium is crucial for bone mass maintenance and preventing further loss. Increasing her intake will no doubt be key for treating Mary's osteoporosis but it should be part of a more comprehensive treatment plan, as others have been discussing.
  • I am particularly interested in the connection between family history and my own risk for osteoporosis once I reach menopause. My grandmother did end up having osteoporosis and had a very humped back later in life. She did have falls and I remember her breaking her arm quite badly. However, my mother does not seem to be at risk of osteoporosis. Could I still be at risk? Is Osteoporosis genetically linked? Should I consider going for bone density scan at some point when I'm older to get a base line?
    • @ChantalSayers these are all very good questions and I have similar concerns. I am unable to have dairy and my mother had osteoporosis later in life. I have a number of questions and I find that the answers my doctor gives me change annually.
  • The use of Hormone Therapy (HT) in the treatment and prevention of osteoporosis remains somewhat controversial. Results from the WHI (Women's Health Initiative) Study show benefits to bone by preventing fractures as well as reducing colorectal cancer, but at an increased risk of cardiovascular events, breast cancer and some blood clots. Many of the negative effects did not occur more frequently in the first 4 to 5 years of HT in the WHI study. HT does help reduce peri-menopausal symptoms and may be used short-term (less than 5 years) with most experts agreeing this is a good situation to use such a therapy. The controversy is around the benefits vs. the risks of HT to prevent and treat osteoporosis when other therapies exist. This is a very personal decision (to take HT or not) and should be a shared-informed decision made with the patient and a healthcare provider well-informed about the evidence and can explain the risks and benefits to a patients so they can make a well-informed choice which respects their personal preferences and concerns. There is data from studies that demonstrate the benefit of HT in both preventing the development of osteoporosis as well as treating osteoporosis to prevent fractures. Some experts may suggest to use HT around the perimenopausal time for women for up to 5 years and then switch to another osteoporosis therapy for people at moderate to high risk of osteoporotic fractures. There are many choices for osteoporosis treatment as well as a range in costs of the therapy and differences in coverage by government payers and private payers. Speak to a well-informed healthcare provider about the choices and which one to start first since the sequence of treatment has been shown to have an impact how beneficial these agents are on the bone.
    • The results of that study in to the effects of HT on osteoporosis are very interesting. My mother had osteoporosis but there is a very high risk of cancer in my family so I wouldn't think that treatment would be the best choice for me should it be warrented
    • Thanks for weighing in @Dr. Alan Low! This is a very interesting perspective as I assumed HRT was used as a 'blanket treatment' for menopausal women. It definitely sounds as though an open dialogue with your family doctor or healthcare professional is a good starting point to weigh all of the evidence and determine if it's the right course of treatment given your particular condition.
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