A 45-year-old Caucasian woman seeks advice from her primary care physician regarding her risk for osteoporosis and the need

A 45-year-old Caucasian woman seeks advice from her primary care physician regarding her risk for osteoporosis and the need for bone density screening. She is a lifelong nonsmoker and drinks alcohol only socially. She has a history of moderate-persistent asthma since age 12 . She is currently on fluticasone, 44 m g / puff twice daily, with good control currently. She last required oral prednisone therapy about 6 months ago when she had influenza that was complicated by an asthma flare. She took prednisone for a total of 14 days. She has had three pregnancies and two live births at ages 39 and 41 . She currently has irregular periods occurring approximately every 42 days. Her follide-stimulating hormone level is 25 m I U / L and 17 β -estradiol level is 115 p g / m L on day 12 of her menstrual cycle. Her mother and maternal aunt both have been diagnosed with osteoporosis. Her mother also has rheumatoid arthritis and requires prednisone therapy, 5 m g daily. Her mother developed a compression fracture of the lumbar spine at age 68. On physical examination, the patient appears well and healthy. Her height is 168 c m