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o Worked part time in service industry.

o Casual social contact through hobbies.


o He was not very social as an adult.
o He was online games, worrying and picking his toe nails (obsessive
behavior)
o He didnt smoke, drink alcohol or use illicit drugs.
o His mother was of French Canadian and Native American ancestry
o His father was of Dutch and English ancestry.

On Examination
Blood Pressure: 125/86mm Hg
Pulse Rate: 67beats/min
Height: 167cm
Weight: 70kg
Head Circumference: 56cm
Body Mass Index: 25.1

o Patient looked older than his stated age and a prominent forehead.
Lower jaw and nasal bridge. Thinkened nose and receded hairline.
o Teeth were short, wide spaced and discolored (not opalescent) with
some periodontal disease.
o Palate and uvula were normal.
o Sclerae pale blue.
o Slight central obesity, muscle wasting
o Normal virilation and testes.
o Small joints of hands and fingers had notable laxity (2/9 on Beighton
scale of hypermobility).
o Large joints were mildly contracted.
o There were patches of vitiligo and hypertension from sun exposure,
with no pigmented striae or bruising.
o He had truncal hypotonia, mild kyphosis and no scoliosis or vertebral
tenderness.
o Spoke with flat affect, had insight and made jokes at times
o Remainder of examination was normal.

Calcuim supplementation and continuation of vit D supplementation and thyroid
replacement therapy were recommended.
Exercise with weight-bearing and strength training was also advised.


A. Family Health History

o Maternal aunt had osteoporosis and multiple fractures after 45yrs of age
after falls.

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