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.