In terms of medical treatment,  I'm inclined to suggest a 5mg/day dose of alendronate as a preventive measure.  We aren't absolutely certain that she has osteoporosis or just osteopenia.  In the mean time,  I would suggest she under go DXA evaluation for a definitive diagnosis of her status.  I would also combine the alendronate with 1500mg of calcium and 800 IU of vitamin D.

I would also suggest that she undergo an exercise program: this will help increase her bone mass as well as improving flexibility and strength to prevent falls.

Should the test be positive for osteoporosis.  I would recommend either remaining on alendronate to maintain BMD and decrease the risk of fracture since the bisphosphonates are shown to be the most effective treatment.

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1) MEDICAL TREATMENT:

Knowing that Mary's mother had an osteoporotic fracture, Mary should have her bone density assessed. Dual-energy absorptiometry is preferred to Quantitative computed tomography because of precision and lower radiation doses.  Diagnosis of osteoporosis will be instrumental in determining whether or not the focus of managment will be treatment or prevention.

Dietary concerns are important on top of the vitamin and mineral supplements in both cases. There should be some discussion about actual foods to focus on as well, i.e. dairy, fish with bones, tofu, etc.

A comment on the excercise: perhaps we can specifically mention weight-bearing, aerobic, and resistance exercises are helpful for reducing future risk of fracture in general.

Colles fractures are notorious for displacing after reduction, so follow up radiographic imaging would be necessary to monitor alignment of the bone during healing.

Should also be concerned that general mobility will decrease after fall due to apprehension about osteoporosis. Exercise must be encouraged, and exercises must be used to maintain strength and muscle mass at other joint sites and nearby limbs.

Pain management needs to be addressed as well. After 6 weeks, she is taking acetomenophin but the adequacy of the pain management regimen needs to be further investigated.

To address the swelling, and this needs to be addressed perhaps via anti-inflammatories or perhaps aspirin, or ibuprofen.

Anabolic agents should be considered to be administered alongside bisphosphonates if Mary is diagnosed with osteoporosis.

2) P/T:
Wrist Range of motion exercises during healing, and this should be the focus especially at the 6 week mark, after all the soft callus formation should have taken place. Reassessment after 2 weeks. 7 hand/writst ROM 10 minutes a day. ADL will be needed from OT. There is funcitonal limitation; short term goals for physio: want to increase functional ability and ROM, and reduce swelling. Exercises can increase cirulation and decrease swelling too. 

3) O/T:
ADL: activities of daily living. Reported difficulty with zippers and jars. Evaluate ability and perhaps will require OT assistance to make suggestions around the home to ease the transition while healing. Perhaps fewer jars, training to use other hand instead while left wrist heals. Some of the basic ADLs are affected, namely dressing, and instrumental ADLs include preparing meals (opening jars)

4) Medical Education/ Nursing/ Preventative Medicine:
Mary has many unanswered questions about osteoporosis; she should be informed about the diagnosis and the implications on her everyday life so she can manage her condition. Although there is no cure, there is a great deal that can be done to improve the prognosis and to preserve quality of life in terms of lifestyle changes and medical management. 

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