Question

Mary-Lou’s family was happy with the management plan established by the doctor as Mary-Lou was progressing quite well. She was using notepads to jot down reminders, a pillbox to keep her medication organized and a calendar to record appointments. Her family members were helping her with routine tasks such as cooking and paying bills. She was feeling much happier and did not have to rely on alcohol to go to sleep. On one particular day she was feeling so good she decided to walk to her GP appointment alone. On her way there she stumbled over a branch and fell. She felt excruciating pain in her hip. A passer-by called an ambulance and she was taken to the emergency department at the Royal Melbourne hospital. An X-ray revealed that she had broken the neck of her femur and had to have surgery to repair it.

Mary-Lou wondered whether this was linked to the crepitus she had been experiencing in her joints. Her joints did feel quite stiff and painful lately. The specialist explained to Mary-Lou that the crepitus was likely due to degeneration of her cartilage and said that the fracture might have been due to weakened bones. He told her he would like her to have a bone mineral density test to measure her bone density. The DEXA scan gave a T-score of -3.0. Mary-Lou is now given bisphosphonates and told to increase her daily intake of calcium.

Considering Mary-Lou’s T-score, identify the condition she suffers from, briefly describe the pathogenesis of this disease, and explain why bisphosphonate administration is helpful in this condition.

Answer 1

Identification:Mary suffer from osteoporosis .

Explaination:

Tscore=- 2.5 or below -2.5 indicate osteoporosis

Marry's Tscore is -3 which is less than -2.5 so she is suffering ftom osteoporosis.

Pathogenesis of osteoporosis :

Osteoporosis is system skeletal system which is caused by either failure in achievement of peak bone mass or due to excessive bone reabsorption by osteoclasts as compare to bone formation by osteoblasts during remodelling process.

80% of peak bone mass achievement depends on genetic factors while remaining was affected by environmental factors such as nutrition diet, smoking habits, exercise .

Malnutrition, smoking and low level of exercise along with genetic factors  are responsible for failure to achieve peak bone mass .

During adult hood Imbalance in bone reabsorption and bone formation is caused by differential activity of osteoclasts and osteoblasts also depend on genetic factors and hormonal imbalance leads to osteoporosis.

Secondary osteoporosis is occur at old age in females after menopause due to decrease in level of estrogen hormone.

Biphosphate administration is helpful in osteoporosis condition because biphosphates are synthetic analogues of pyrophosphate which have a very high binding affinity for bone mineral so causes reduction in activity of osteoclasts cell which causes reabsorption of bone. So by decreasing activity of osteoclasts the reabsorption of bone mass reduced and help to compensate the imbalance between bone reabsorptiona and bone formation.