A 60-year-old white woman presents for an office visit. Her mother recently broke her hip, and the patient is concerned about her own risk for osteoporosis. She weighs 165 lb and is 5 ft 6 in tall. She has a 50-pack-year history of tobacco use. Medications include a multivitamin and levothyroxine 50 mg/d. Her exercise regimen includes mowing the lawn and taking care of the garden. She took hormone replacement therapy for 6 years after menopause, which occurred at age 49. Which recommendation for osteoporosis screening is most appropriate for this patient?

**Core Concept**
Osteoporosis screening involves evaluating an individual's risk factors and bone density to determine the need for further testing and treatment. This patient's history, including a family history of hip fractures, tobacco use, and a history of hormone replacement therapy, places her at increased risk for osteoporosis.

**Why the Correct Answer is Right**
The correct answer is based on the patient's 50-pack-year history of tobacco use, which is a significant risk factor for osteoporosis. Additionally, the patient's history of hormone replacement therapy, although potentially beneficial for bone health, may not have been sufficient to prevent bone loss over time. The patient's exercise regimen is inadequate, as regular weight-bearing and resistance exercises are essential for maintaining bone density. Therefore, the most appropriate recommendation for osteoporosis screening would be to perform a bone mineral density (BMD) test, also known as a dual-energy X-ray absorptiometry (DXA) scan.

**Why Each Wrong Option is Incorrect**
**Option A:** A BMD test is not necessary for this patient, as she has a low risk for osteoporosis based on her age, weight, and height.
**Option B:** This patient's history of hormone replacement therapy and family history of hip fractures make her a higher-risk candidate for osteoporosis, making a BMD test more appropriate than a general health examination.
**Option C:** While exercise is essential for maintaining bone density, this patient's current exercise regimen is inadequate, and a BMD test is still necessary to assess her risk for osteoporosis.
**Option D:** This option is incomplete.

**Clinical Pearl / High-Yield Fact**
Patients with a 50-pack-year history of tobacco use are at increased risk for osteoporosis, and a BMD test should be considered to assess their bone health.

**Correct Answer: C.**

✓ Correct Answer: B. Dual-x-ray absorptiometry (DXA) scan