Gretchen, a 65-year-old female, came into the clinic for follow-up care related to her chronic bronchitis. She has had bronchitis for several years and had an acute episode of respiratory distress 2 months ago. Treatment for the acute respiratory symptoms included the corticosteroid prednisone. She was initially given a high dose of prednisone, but was able to tolerate a reduced dose of 10 mg per day since that time. A review of Gretchen's medical history revealed that she smokes one pack of cigarettes per day, a habit that she has had for 50 years. She indicated that she was healthy and didn't see the need for any other medications. She stated that her diet was good, although she had difficulty digesting dairy products and therefore avoided them. She recently was experiencing low back pain, but otherwise has no complaints. Physical examination showed that Gretchen's BMI was 17, her weight reduced by 5 pounds since her last visit. Her height was 0.5 in. less than the previous visit 6 weeks prior. Her posture appeared to be stooped and she had difficulty standing up straight. A DEXA scan indicated a T score of -2.5, compared to her score of -2.0 twelve months before. An X-ray indicated the presence of a vertebral fracture at L3.

1. What is the pathophysiology associated with Gretchen's clinical presentation?

2. What are the risk factors associated with the condition?

3. What are the clinical manifestations that Gretchen demonstrates?

4. How can Gretchen be diagnosed?

5. What is the treatment for Gretchen?

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