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Answer 3
  1. Vitamin D and calcium. This patient is quite young to be presenting with senile osteoporosis; he should be evaluated for secondary causes of this problem. Basic tests should include a complete blood count, kidney and liver function tests, vitamin D and calcium level measurements, and measurement of testosterone and thyroid hormone levels.2 Vitamin B1-2 and folic acid deficiency have not been associated with osteoporosis, nor have electrolytic abnormalities of sodium, potassium, or magnesium. Although growth hormone abnormalities could indicate a pituitary disorder, the patient would have earlier presented with many other problems, including hypogonadism, thyroid, and/or cortisol problems.

    1. Kearns AE, Thompson GB. Medical and surgical management of hyperparathyroidism [published erratum appears in Mayo Clin Proc 2002;77:298]. Mayo Clin Proc 2002;77:87-91.
    2. Orwoll ES. Osteoporosis in men. Endocrinol Metab Clin North Am 1998;27:349-67.

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