WORKUP IN SYMPTOMATIC DISEASE Causes of symptomatic bone loss must be systematically excluded. The patient’s history may suggest bone loss secondary to hyperthyroidism, primary hyperparathyroidism, chronic glucocorticoid excess (hyperadrenalism or…
Multiple myeloma, the most common primary malignant bone tumor in adults, may be associated with profound generalized axial and appendicular osteopenia. Myeloma cells produce potent osteoclast-activating factors that stimulate bone…
Hyperadrenalism, or chronic glucocorticoid excess, whether endogenous (Cushing syndrome) or iatrogenic, leads to decreased bone mass. Glucocorticoid therapy results in a transient increase in bone resorption followed by a suppression…
In patients with HPP the predominant organs involved are the skeleton and teeth, which are hard tissues, even though there are high levels of TNSALP in many organs. Four of…
Osteoporosis is a heterogeneous disorder that is caused by multiple pathogenetic mechanisms. The clinical manifestation of osteoporosis is fracture, and the mechanisms that lead to fracture are multifactorial and include…
The circulating 25(OH)D concentration is the most reliable measure of overall vitamin D status, even though it is biologically inactive. 25(OH)D is measured by commercially available immunoassays, preferably by automated…
The biochemical alterations in renal osteodystrophy can be summarized as follows: 1. Azotemia, hyperphosphatemia, and changes in acid-base balance and electrolytes that reflect the chronic acidotic state 2. Low serum…
Radiographic examination of the skull may show irregular rarefaction of the calvaria (“salt-and-pepper” skull) and loss of the dense white line cast by the lamina dura surrounding the roots of…
Treatment of rachitic and osteomalacic syndromes due to renal tubular acidosis should focus on the primary process rather than on the bone disease. Administration of alkali in the form of…
Rickets or osteomalacia of variable degrees is a common manifestation of all the diverse conditions associated with renal tubular acidosis. Some of the rachitic disorders are life threatening, such as…
