QuestionSBA
QuestionChoice
Metformin doesn't cause cardiac side effects therefore ECG monitoring isn't warranted.
50426
c
ECG
QuestionChoice
Whilst metformin can cause a reduced absorption of vitamin B12, this is a very rare side effect and therefore isn't routinely monitored.
50427
d
Full blood count
QuestionChoice
Whilst metformin can cause hepatic injury through hepatitis, this is a very rare side effect and therefore isn't routinely monitored for.
50425
b
Liver function tests
QuestionChoice
Metformin doesn't cause side effects involving the thyroid therefore thyroid function test monitoring isn't warranted.
50428
e
Thyroid function tests
QuestionChoice
One of the most important side effects of metformin is lactic acidosis. Renal impairment increases the likelihood of this occurring due to improper clearance of metformin. It is therefore very important to monitor renal function prior to starting metformin therapy.
50424
a
Renal function
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3668
Renal function should be monitored before starting metformin due to the increased risk of lactic acidosis
Topic
131
Obstetrics & Gynaecology/Paediatrics
10139
Case Presentation:  A 31-year-old woman attends the outpatient gynaecology department.


**PMH** Polycystic ovary syndrome, Depression

**DH** Sertraline 50mg PO OD

She wants to conceive and has already been treated with clomifene citrate. Unfortunately, this hasn't worked and her Gynaecologist has recommended metformin 500mg PO OD as the next step in her management.

Question: Which investigation should this patient undergo prior to starting metformin?
a