Pearson: Clinical Case 2

Question 1

What is primary osteoporosis?

Answer 1

deterioration of bone mass that is unassociated with other chronic illness

Question 2

What is secondary osteoporosis?

Answer 2

Chronic conditions that contribute significantly to accelerated bone loss.

These chronic conditions include endogenous and exogenous thyroxine excess, hyperparathyroidism, malignancies, gastrointestinal diseases, medications, renal failure and connective tissue diseases

Question 3

When is BMD testing recommended?

Answer 3

In women age 65 and older and men age 70 and older, recommend bone mineral density (BMD) testing.

• In postmenopausal women and men age 50-69, recommend BMD testing when you have concern based on their risk factor profile.

Question 4

When do you initiate treatment for osteoporosis?

Answer 4

those with hip or vertebral (clinical or asymptomatic) fractures

Question 5

What is the T score in a Dexa scan?

Answer 5

The T-score shows the amount of bone the patient has compared to a young adult (at the age of 35) of the same gender with peak bone mass T-scores are based on the standard deviation, which reflects differences from the average score.

Question 6

What is a Z score?

Answer 6

Z-scores are calculated in the same way, but the comparisons are made to someone of approximately the same age, sex, race, height, and weight

Question 7

Who do you want to treat for osteoporosis?

Answer 7

Pts who have had fragility fractures

pts who are osteopenic and are at high risk (FRAX calculator)

Question 8

What lab do you order to check vitamin D?

Answer 8

Vit D (25- Hydroxyvitamin D)

Question 9

What causes primary hyperparathyroidism?

Answer 9

enlargement of one or more of the parathyroid glands

Question 10

What is secondary hyperparathyroidism?

Answer 10

the body produces extra parathyroid hormone because the calcium levels are too low

Question 11

What drives PTH?

Answer 11

calcium levels

Question 12

What are common symptoms of PTH?

Answer 12

Stones, bones, groans and moans

Question 13

What tests are done to evaluate hyperparathyroidism?

Answer 13

increased levels of parathyroid hormone (PTH), calcium, and alkaline phosphatase, and lower levels of phosphorus.

A 24-hour urine collection test helps to determine how much Ca is being removed from the body.

Question 14

How much Ca is recommended for menopausal women?

Answer 14

1200 mg Ca (replace up to this level)

Question 15

How much vit D is recommended for women?

Answer 15

600-800 IU

Question 16

How is Vit D def defined?

Answer 16

Deficiency is defined as a serum 25-hydroxyvitamin D level of less than 20 ng per mL (50 nmol per L)

insufficiency is defined as a serum 25- hydroxyvitamin D level of 20 to 30 ng per mL (50 to 75 nmol per L).

Question 17

What acts as a reservoir for Ca?

Answer 17

Bone

Question 18

What organs eliminate or retain/recover Ca?

Answer 18

Kidney and GI

Question 19

What two hormones are involved in the regulation of Ca?

Answer 19

PTH

Active vitamin D3= calcitriol

Question 20

What controls Ca deposition?

Answer 20

Osteoblasts

Question 21

What controls Ca mobilization?

Answer 21

osteoclasts

Question 22

What does PTH do?

Answer 22

Mobilizes Ca from bone in response to HYPOcalcemia

Enhances renal absorption of Ca

Regulates the activity of 1,25(OH)D-1a-hydroxylase> INCREASES vit D

Question 23

What type of hormone is PTH?

Answer 23

peptide hormone

Question 24

What type of receptor is PTHR?

Answer 24

GPCR

Question 25

What is calcitriol?

Answer 25

active vit D3= 1,25 dihydroxycholecalciferol

Question 26

What does vit D do?

Answer 26

promotes absorption of Ca from the GUT

Question 27

What type of hormone is vit D? What is VDR?

Answer 27

steroid hormone

Nuclear receptor superfamily and a heterodimer partner w/ RXR

Question 28

Describe the steps required to convert inactive vit D3 to active vit D3.

Answer 28

Vit D3>
blood>
liver>
25 hydroxylase > 25 hydroxyvitamin D3>
Blood>
Kidney>
1 aplha hydroxylase> 1,25-dihydroxyvitamin D3>
bones, intestines, kidneys