In Osteoporosis which of these is seen?
Ans. a. Normal calcium, normal ALP (Ref: Harrison 19/2493, 18/3120; Apley 9/131-133)Serum calcium, phosphate and alkaline phosphatase are normal in osteoporosis.OsteoporosisOsteoporosis is the MC metabolic bone disease.Osteoporosis is a state of decreased mass per unit volume (low bone density) of a normally mineralized bone.Causes of OsteoporosisDrugs Causing Osteoporosis* Immobilization* Senility* Post-menopausalQ* Cushing's disease,* Cushing's syndrome* Hyperparathyroidism* Type 1 DM* Acromegaly* Hyperprolactinemia* Osteogenesis imperfecta* Marfan's syndrome* Hypophosphatasia* Homocystinuria* Ehler's Danlos syndrome* Multiple myeloma* GlucocorticoidsQ, Cytotoxic drugsQ* Aromatase inhibitors* LithiumQ, Aluminium* CyclosporinQ, Excessive alcohol* HeparinQ, Aromatase inhibitors* Excessive thyroxineQ* GnRH agonistsClinical features:Osteoporosis is an asymptomatic disorder unless complications (predominantly fractures) occurMC symptom of osteoporosis is back pain secondary to vertebral compression fractureSites of Osteoporotic (Fragile) FracturesMC site: Fracture vertebrae (Dorsolumbar pine is the MC site)QColle's fracture; Fracture neck femurSerum calcium, phosphate and alkaline phosphatase are normal in osteoporosisQDiagnosis:At least 30% of the bone mass must be lost before it becomes apparent on X-ray.Osteoporosis: X-ray findingsLoss of vertical height of a vertebra due to collapseQCod-fish appearance: The disc bulges into the adjacent vertebral bodies so that the disc becomes biconvexQ.Ground glass appearance of the bones, conspicuous in bones like the pelvisMeasurement of Bone MassNoninvasive techniques for estimating skeletal mass or density: Dual-Energy X-ray Absorptiometry (DEXA), single-energy X-ray absorptiometry (SEXA), quantitative CT, and ultrasound (US).Dual energy X-ray Absorptiometry (DEXA) is the gold standard for the screening (estimation) of bone density and bone mass and for diagnosis of osteoporosisQ.Drugs useful in OsteoporosisInhibit Bone ResorptionStimulates Bone FormationBoth action* Bisphosphonates: Alendronate, Risedronate,EtidronateQ* Calcium receptor agonist: Cinacalcet* CalcitoninQ* SERMs: Tamoxifen. Raloxifene* Gallium nitrateQ* RANKL Inhibitors: Donesumab* TeriparatideQ* Calcium* CalcitriolQ* Fluoride* Strontium ranelateQ
Normal calcium, normal ALP
Decreased calcium, increased ALP
Decreased calcium, decreased ALP
Normal calcium, decreased ALP
Metabolic Disorders Leading to Osteosclerosis