Hyperparathyroidism Case Flashcards
What is primary osteoporosis?
it’s deterioration of bone mass that is unassociated with other chronic illness
What is primary osteoporosis related to?
aging and decreased gonadal function
therefore, early menopause or premenopausal estrogen deficiency states may hasten the development of osteoporosis
Besides menopause, what are some other risk factors that can contibute to primary osteoporosis?
inadequate calcium intake sedentary lifestyle tobacco alcohol abuse female gender petite body frame white or asian ancestry nulliparity increasing age high caffeine intake renal disease low body weight impaired Ca absorption long term use of certain drugs like steroids
What is secondary osteoporosis?
it’s osteoporosis that is reuslting from a chronic conditions
What are the basic recommendations we can make to postmenopausal women and men aged 50 and over regarding osteoporosis
- counsel on risk and related fractures
- check for secondary causes
- advice on a diet rich in fruits and veggies that give enough calcium in a day
- advise on vitamin D intake
- recommend regular weight bearing and muscle-strengthening exercise
- advise against smoking and drinking
- recommend bone dnesity testing
When should you advise bone density testing?
in postmenopausal women and men age 50-69 IF you have concern based on their risk factor profile
or to those who have had a fracture
What type of fractures should you immediately start treated for osteoporosis?
hip and vertebrae
How do you determine bone density?
you do a DEXA scan
What does the T-score of a DEXA scan tell you?
It shows the amount of bone that the patient has compared to a young adult at the age of 35 of the same gender
It’s based on standard deviation, so the score tells you how far the patient is from the mean in terms of standard deviation
So a T score higher than -1 means…
patient has adequate bone density
T score between -1 and -2.5 means…
bone mass is between 1 and 2.5 standard deviations lower than the average healthy 35 yo
osteopenia (fracture risk is twice the average)
T score less than -2.5….
means the bone mass is lower than the average 35 yo by more than 2.5 standard deviations
so bone mass is very low - lower than 99% of health young adults. Risk for fractures is approximately three times higher
this is osteoporosis
What does a Z-score mean on the dexa scan?
The comparison is made the same way as in the T-score, but the comparison is between someone of the same age (not a 35 year old), sex, race, height and weight as the patient
True or false: the Z-score is thus used to confirm a diagnosis of osteoporosis as suggested by the T score in postmenopausal women.
False - it’s not used to confirm a diagnosis of osteoporosis because once a woman reaches an older age past menopause, a favorable BMD measurement compared to the average measurement for the patient’s age groups does not mean she is not at risk for osteoporosis
it just means she doesn’t have increased risk compared to her peers…but they’re all postmenopausal, so they’re all at risk
the z-score can be used to make a diagnosis in a premenopausal woman
A z-score lower than -2.0 or a z-score that is lower than the T-score suggests what?
secondary osteoporosis
basically it means it’s too severe for it to just be primary
Did our patient have primary or secondary osteoporosis?
secondary
What was it secondary to?
hyperparathyroidism
How does hyperparathyroidism cause osteoporosis?
The high PTH mobilizes the calcium from bone, which makes the bones weaker, contributing to osteoporosis
Besides hyeprparathyroidism, what are some other endocrine causes of osteoporosis?
Just for shits and giggles…
Acromegaly Anorexia nervosa Athletic amenorrhea DM T1 Hemochromatosis Hyperadrenocorticism Hyperprolactinemia Thyrotoxicosis Hypocalcuria Hypogonadism Mastocytosis
What are some collagen and genetic disorders that can cause osteoporosis?
For even more shits and giggles…
Ehlers-Danlos Glycogen storage diseases Homocystinuria Hypophosphatasia Marfan syndrome Osteogenesis imperfecta
What are some medications that can cause secondary osteoporosis?
Again, shits and giggles…
Cyclosporine Devo Provera Excess thyroid hormone Glucocorticoids GnRH agaonists Methotrexate Phenobarbital Phenothiazines Chronic PPI and H2 blockers (decrease calcium absorption from the gut) Phenytoin Heparin - prolonged Aromatase inhibitors High Dose Vit A Thiazolidinediones
What should you include in your basic lab workup of osteoporosis?
Complete metabolic panel with calcium and phosphorous
CBC
Vitamin D level (25-hydroxyvitamin D is typical)
TSH
Sed Rate
Also consider a 24 hr urine for calcium and creatinine
If you are evaluating osteoporosis and you find an increased creatinine level, what is the primary cause?
renal disease
If you are evaluating osteoporosis and you find increased hepatic transaminase levels, what is the primary cause?
hepatic disease
