Case: A 56-year-old Caucasian woman is seeing an orthopedist for the first time.
ID: 3480256 • Letter: C
Question
Case: A 56-year-old Caucasian woman is seeing an orthopedist for the first time. She reports a history of several fractures. Six months ago, she sustained a right wrist fracture after falling over a lamp cord in her single-level carpeted home; 2 months later she fractured her left wrist after tripping and falling. Five years ago she fractured an ankle while making a (bad) landing while sky-diving for the first time - and last - time. She had a hysterectomy at age 45 for fibroids; the ovaries are were not removed. She experienced menopause at age 51 and has not taken hormon therapy. She is healthy and has not been on chronic medications. Her dietary calcium intake is consistent at about 950 mg daily. She does not use any over-the-counter medications or supplements and does not smoke. She uses sunscreens to protect against skin cancer. She does not engage in regular weight-bearing exercise. Her paternal aunt was diagnosed with osteoporosis after a hip fracture. The patient is 5'1" and she weighs 105 lbs. Her height has been stable over the past 3 years. A general health assessment in the prior year included a chemistry profile, thyroid studies, urinalysis, and CBC, all of which were normal. A review of the patient's previous medical records revealed that a spine x-ray had been done for persistent back pain about 4 months after her sky-diving accident. The x-ray revealed severe compression fractures at L1 and L2, with radiographic evidence of low BMD or osteopenia at other sites. It is likely that the compression fractures were traumatic and related to the skydiving accident. Radiographic evidence of low BMD is an insensitive finding, and is not diagnostic of osteoporosis, But, once such radiographic evidence of low BMD is found, it should be further evaluated with more definitive testing.
** What cell types in bone tissue are important for bone remodeling and may be part of the cause for osteoporosis? What can a doctor recommend for long-term management of osteoporosis?
** Although a bone density scan is the test that verifies a diagnosis of osteoporosis, what results from the other tests mentioned in this case (chemistry profile, thyroid studies, urinalysis, and CBC) would contribute to the diagnosis?
Explanation / Answer
Answer-1: Osteoporosis is a disorder in which the bones become porous and brittle due to erosion. It occurs when the bone resorption exceeds the bone production.
Osteoblasts are the cells that are responsible for building bones, these osteoblasts move over the matrix and deposit osteoids, a mixture containing high amount of collagen, then it deposits mineral such as calcium into the osteoids and form bones.
Osteoclasts are the cells that are involved in the resorption of the bone, which is the process of the breakdown of bones and releasing minerals into the bloodstream. Osteoclasts travels to the surface of the bone and causes its disintegration through sscretion of enzymes and acids.
these are two main cells that are responsible for bone remodeling and are a part of the cause of osteoporosis. Regulation of osteoclasts and osteoblasts can be affected by various factors such as hormonal, which is due to menopause which causes lack in estrogen which causes increase in bone resorption.
For long term management of osteoporosis a doctor would recommend lifestyle change and mainting a healthy lifestyle through exercise and nutrition. Weight bearing exercise can help strengthen muscles and bones, adequate intake of vitamin D and calcium, vitamin D is needed for calcium absorption. Cessation of smoking and alcohol.
Medication like Bisphosphonates help prevent future fracture in people who have already had a fracture due osteporosis.
2: Other tests mentioned that would contribute to the diagnosis of osteoporosis:
Chemistry profile- Checking Blood calcium levels is a normal procedure for osteoporosis, vitamin D can also help determine the disease as low levels points toward decreased calcium absorption in the intestine, and an increased level of alkakine phosphatase tells that there is a problem with the bone.
Thyroid studies- Measuring t3 and t4 and tsh level to determine thyroid disease, and check for hyperparathyroidism by measuring parathyroid enzyme, which are key regulatory factor in bone health its production and reabsorption.
Urinalysis- Ostex test can help identify if your body is removing bone rapidly, because in osteoporosis the body break down bone actively and excrete the byproducts via urine.
CBC- A normal CBC eliminates diseases of the bone marrow such as leukemia or myeloma, both of which can cause osteoporosis and Fragility Fractures.