Of course after I post this email, I stumble on what I think is the answer.

Is it related to caching of secondary exchange mailboxes that are open in the 
users profile?
http://www.msoutlook.info/question/561



From: [email protected] [mailto:[email protected]] On 
Behalf Of Jimmy Tran
Sent: Monday, May 05, 2014 5:07 PM
To: [email protected]
Subject: [Exchange] Why is OST so much larger than Mailbox size?

I have a user who has a 7GB mailbox size but yet her outlook OST is 48GB.  User 
is has Outlook 2010 and using Outlook 365.  Any idea's?  Google isn't giving 
any good answers.

TIA,

Jimmy



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