Question

A 63-year-old woman reports for her annual physical examination. She has no major previous medical history but does have a recent history of a broken wrist she sustained after a mild fall. Three years ago her height was recorded at 5’3” and is now recorded at 5’1”. She complains that she can’t be quite as active as she used to be and that her back is beginning to bother her. This leads her to be outside less frequently. Her physician orders some laboratory testing and diagnoses her with osteoporosis.

Analyte	2/20/2018 08:00	Reference Range
Na	141	135-145 mEq/L
K	4.1	3.5-5.0 mEq/L
Cl	101	95-105 mEq/L
CO2	25	22-28 mEq/L
Glucose	98	70-100 mg/dL
BUN	15	7-20 mg/dL
Creat	0.9	0.5-1.1 mg/dL
BUN/Creat Ratio	17	10-20
Calcium	10.4	8.5-10.5 mg/dL
25-Cholecalciferol	15	25-80 ng/mL
iPTH	89	10-65 pg/mL

1. Highlight the abnormal results in the above table.
2. List three risk factors this patient has for osteoporosis.
3. What is the most likely cause of her case of osteoporosis? Explain.
4. What are two treatments that could be used for this patient and how would each be effective?

Answer 1

Abnormal results are-

1)25- cholecalciferol : Low

2)iPTH: High

Risk factor for this patient-

1)post menopausal female-post menopausal female are particularly susceptible because of estrogen deficiency.

2) Hyperparathyroidism-a disease wherein there is excessive parathyroid hormone production by the parathyroid gland (a small gland located near the thyroid gland). Normally, the parathyroid hormone maintains blood calcium levels by, in part, removing calcium from the bone. In untreated hyperparathyroidism, excessive parathyroid hormone causes too much calcium to be removed from the bone, which can lead to osteoporosis.

3)Vitamin D deficiency-vitamin D helps the body absorb calcium. When vitamin D is lacking, the body cannot absorb adequate amounts of calcium to prevent osteoporosis. Vitamin D deficiency can result from lack of intestinal absorption of the vitamin such as occurs in celiac sprue and primary biliary cirrhosis

* I think most probably hyperparathyroidism is the cause for her because in hyperparathyroidism there is increase level of PTH which is diagnosed and due to this excessive bone resorbtion occur and demineralization of bone occur thus the bone getting fragile and prone to damage.so it is a secondary osteoporosis.

*Treatment:

Bisphosphonate- bisphosphonate is the primary or first line treatment for osteoporosis.these are a class of drugs with a central core of P-C-P atoms,to which various side chains are attached.following administration,they target bone surfaces and are ingested by osteoclasts during the process of bone resorbtion.this bisphosphonate is released within the osteoclasts and impairs bone resorption.this in turns causes an increased mineralization of bone,rather than an increase in bone mass.

Oral bisphosphonate are given for 5 years.

calcium and vitamin D- 1000 mg of calcium and 800 IU vitamin D should be given daily