The month’s case involves a lawsuit against 2 healthcare professionals, a primary care physician and a rheumatologist. The patient, Mrs X, was a postmenopausal woman in her early 50’s. The mother of 3 adult children who had successfully worked for 15 years in the IT department of a Fortune 500 firm until her scleroderma made it increasingly difficult to type on a computer.  

Mrs X was a longtime patient of 2 physicians, her primary care doctor, Dr P, and her rheumatologist, Dr R, who had been managing her scleroderma for over a decade. Mrs X used prednisone on an as-needed basis to address the pain of her chronic condition. When it became too difficult for Mrs X to use the computer at work, and travel via public transportation, she went on permanent disability.  In addition to the scleroderma, Dr R had also diagnosed the patient with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, specifically perinuclear ANCA, earlier in her treatment.

Despite Mrs X’s conditions, her creatinine and other metabolic assessments were within a normal range on her tests, and the patient regularly went to her doctor appointments over the course of the decade.

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Following a bone density scan as part of her regular appointment with Dr R, it was revealed that Mrs X was suffering from a moderate to high degree of osteopenia. Dr R explained to the patient that this would make her more susceptible to fractures and suggested that she start on a medication regimen to mitigate the bone loss. 

He offered her 2 medication options, zoledronic acid or denosumab, plus the option of watchful waiting. He explained to Mrs X that zoledronic acid was a once a year treatment, while denosumab required injections every 6 months. Zoledronic acid was well covered by the patient’s drug plan, while denosumab was not.