Metabolic Bone Diseases

Calcium and Phosphorus Disorders

Calcium and phosphorus are two minerals essential to our bodies.  Together, they help to strengthen the bones and teeth.  If either one is out of balance, the body can be affected adversely.  The most common calcium and phosphorus disorders include:

  • Hypercalcemia refers to an overabundance of calcium in the blood.  Treatment varies depending on the cause of the high calcium levels, but may include the administration of certain medications (such as steroids and diuretics) to improve the blood calcium level.
  • Hypocalcemia refers to the situation when there is too little calcium is present in the blood.  Calcium or vitamin D supplementation may be necessary.  If the problem is severe, sometimes intravenous calcium is indicated.
  • Hypophosphatemia refers to a low level of phosphorus in the blood. Treatment may involve nutritional therapy with high phosphate levels, plus medical supplements and medications to normalize the phosphorus levels.

Hyperparathyroidism

Hyperparathyroidism is common medical condition where one or more of the parathyroid glands (which are responsible for controlling the calcium levels in the blood) begin to produce too much parathyroid hormone (PTH), resulting in the rise of blood calcium to above-normal levels (hypercalcemia). While many patients have no symptoms to indicate that the calcium levels are too high, it is felt that many people do not realize that they are experiencing symptoms related to the hypercalcemia until the problem is cured, at which time they feel notably better.  Common symptoms of hyperparathyroidism with hypercalcemia (when they do occur) include increased thirst, increased frequency of urination, abdominal pain, muscle and bone pain, nausea and vomiting.  Patients with hyperparathyroidism are predisposed to develop kidney stones and osteoporosis.  Once diagnosed, the treatment for this problem usually involves referral to a surgeon to remove the parathyroid gland (or glands) that are responsible for the over-production of the PTH.

Hypoparathyroidism

Hypoparathyroidism is a condition caused by an underproduction of parathyroid hormone (PTH) by the parathyroid glands.  If the parathyroid glands do not secrete a sufficient quantity of PTH, the amount of calcium and phosphorus in the body can become severely unbalanced, resulting in problems including cataracts, dry hair, abdominal discomfort, scaly skin, muscle cramps and seizures.

To diagnose hypoparathyroidism, your doctor will perform blood and urine tests to measure the levels of various minerals and PTH.  Treatment for hypoparathyroidism consists of taking daily supplements of calcium and special forms of vitamin D.  Regular follow-up appointments are essential to adjust these medications and ensure that correct levels of blood calcium are steadily maintained.

Osteomalacia

Osteomalacia, also known as rickets, is a softening of the bones that may occur as a result of a vitamin D deficiency. This condition often leads to a dull aching pain, muscle weakness and an increased risk of fractures, especially within the ribs, spine and legs. If this condition is suspected, your doctor may perform diagnostic testing such as X-rays or a bone mineral density test to evaluate the health of the bones and determine the underlying cause of symptoms.

Osteopenia

Osteopenia is a condition characterized by low bone mineral density, but not as low as that seen in the condition known as osteoporosis.  The usual cause is the loss of calcium and other important strengthening factors from the bone.  If excess minerals from the bones are lost, they become weakened and more predisposed to fractures.

Osteopenia can be a result of the natural aging process, eating disorders, problems with absorption of vitamins, or as a side-effect of certain medications. There are no symptoms associated with osteopenia, but those patients with the condition have a higher risk of bone fractures. The problem is diagnosed through bone mineral density testing. Treatment for osteopenia often consists of making lifestyle changes that help to maintain existing bone mass.  These changes include increasing calcium intake through diet or supplements, and exercising to strengthen the bones.

Osteoporosis

Osteoporosis is a disease characterized by increased bone mineral loss that can lead to fractures, loss of height, and a hump-backed appearance. The problem is very common in older populations.  One in two women and one in five men over the age of 65 will suffer at least one bone fracture due to osteoporosis.

Osteoporotic bones are sufficiently weak so that injury may occur even in the absence of an accident or fall.  Even everyday activities can result in a fracture. For example, spinal compression fractures, which are the most common osteoporosis-related injury, and can be triggered simply by bending over.

A diagnosis of osteoporosis is made after a complete medical history, physical examination, laboratory tests and a bone densitometry examination are performed to rule out other possible causes of bone loss.  Lost bone cannot be replaced, but your doctor will work with you to prevent further weakening of the bone. The treatment plan may include exercise, diet changes, hormone therapy with estrogen (ERT) medications that have similar function to estrogen on the bone (SERMs), or bone-preserving medications such as Calcitonin or bisphosphonates.

Paget's Disease

Paget's disease is a chronic bone disorder that affects bone metabolism and causes bones to become fragile and unable to regenerate correctly. In this disorder, new bone is produced at a faster rate than normal, but the structure of the bone is abnormal.  As a consequence, the new bone is softer and weaker than normal, increasing a patient's risk for pain and fractures.

Patients with Paget's disease may experience bone pain, deformity, fatigue and can experience arthritis in severe cases. Symptoms usually occur in localized areas such as the spine, thigh, pelvis, collar bone or upper arm. Depending on the type and severity of the condition, patients may also feel tingling, numbness or stiffness.

If a patient has no symptoms, treatment may not be required. Other patients with Paget's disease may benefit from oral or injectable medications, anti-inflammatory drugs, special footwear or even surgery for severely damaged bones.

Vitamin D Deficiency

A vitamin D deficiency is a condition where the patient's levels of this vitamin is inadequate to meet their needs.  Humans consume vitamin D in their diet and also naturally produce vitamin D when the skin is exposed to sunlight.  In those situations where the patient's sun exposure is low and they do not consume foods rich in vitamin D, then they are at risk for developing vitamin D deficiency.  Vitamin D is important because it works together with calcium to strengthen the bones.  A vitamin D deficiency can cause such symptoms as bone pain and muscle weakness, but for many people the symptoms are subtle.  This condition has been possibly implicated to increase the risk of cardiovascular ailments, cognitive problems and certain types of cancer.

Vitamin D deficiency is diagnosed through a blood test.  Treatment requires increasing the body’s level of vitamin D by making dietary changes and taking supplements.

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