Osteoporosis

Osteoporosis


What is osteoporosis?
- Osteoporosis is a loss of bone when compared to peak bone mass resulting in increased bone fragility. Osteopenia is also a loss of bone, but not as severe as osteoporosis. Our practice treats both osteopenia and osteoporosis and the diagnostic steps, laboratory workups, and treatments strategies are fairly similar with the exception that the treatment for osteoporosis tends to be more aggressive than that of osteopenia.

Who is affected by osteoporosis?
- Anyone can be affected as we mature, although it seems to be slightly more common in post-menopausal women than in men. This may be due to the fact that women are naturally smaller than men and also more likely to be screened than men. People taking certain medications that can exacerbate bone loss are also at increased risk for osteoporosis.

Why do we treat osteoporosis?
- We treat osteoporosis because the diagnosis implies that bone strength has been diminished resulting in increased bone fragility and more brittle bones. Patients with osteoporosis are at a higher risk for bone fractures or breaks which can lead to further health issues.

What causes osteoporosis?
- The most common cause of osteoporosis is due to the hormonal changes associated with menopause, and in men, andropause. However, our practice regularly screens patients for other causes of osteoporosis including vitamin and mineral deficiencies, malabsorption problems, hormonal abnormalities related to the thyroid, parathyroid, or adrenals, and liver and kidney issues. We also screen for other causes such as blood disorders, and the use of certain medications or substances that can increase the risk for developing osteoporosis.

How is osteoporosis diagnosed?
- Osteoporosis is diagnosed with the use of a bone density DEXA scan (dual-energy x-ray absorptiometry) and our facility is equipped with a state of the art bone density machine.

How is osteoporosis treated?
- First, our practiced professionals screen for secondary causes of osteoporosis using blood and urine studies. If any causes are identified, we address those issues first, either here in our office or with referrals to respected colleagues. Once the secondary causes have been addressed, we confirm that patients are getting appropriate amounts of vitamins and minerals through supplementation or dietary intake. Our practice places a strong emphasis on lifestyle modification, with the incorporation of specific exercises to stimulate bone build up and growth. Lastly, we explain the various types of bone-sparing medications (medications that decrease fracture rate) and find the most suitable medication for each patient. We continue to monitor a patient’s response to the various interventions both with regular laboratory workups as well as bone density assessments.

Metabolic Bone Disorder
There is a wide variety of metabolic disturbances that can result in bone issues, whether they are related to bone loss, or to the abnormal development of bone. As specialists in endocrinology, our practice is equipped to appropriately screen for a broad spectrum of these causes including parathyroid hormone dysregulation, Vitamin D deficiencies, calcium wasting syndromes, thyroid abnormalities, and adrenal dysfunction. Our practice of professionals regularly treats osteopenia, osteoporosis, and Paget’s disease of the bone, all of which can be the result of metabolic disturbances.

Parathyroid Dysfunction

What do the parathyroid glands do?
- The parathyroids are four glands located in the anterior neck, behind the thyroid gland, which are responsible for regulating calcium levels in the body.

What is primary hyperparathyroidism?
- Primary hyperparathyroidism is the most common cause of hypercalcemia. It typically occurs when one or more of the four parathyroid glands hypertrophy or grow an adenoma that begins to produce extra parathyroid hormone, which in turn increases the calcium levels in the blood stream. This calcium typically comes from the bones, which is why this can lead to osteoporosis. The symptoms of hypercalcemia usually include “bones, stones, groans, and moans.” This refers to bone pain and bone loss, kidney stones, stomach discomfort including reflux, nausea, vomiting, constipation, or diarrhea, and changes in moods and mental status.

What is hypoparathyroidism?
- Hypoparathyroidism is typically a result of surgery either of the thyroid or parathyroids. Because of their close proximity, parathyroids are sometimes accidentally removed or damaged during a thyroid surgery resulting in a much lower production of parathyroid hormone and a drop in blood calcium levels. This results in muscular irritability which causes the symptoms of muscle cramps and tingling.

What is the treatment of hyperparathyroidism?
- Typically, diagnostic testing is used to localize the parathyroid gland that is producing extra hormone and then surgical removal of that parathyroid gland is curative. However, if patients are unable to undergo surgery, there are medications and other interventions that can help lower calcium levels.

How are parathyroid and calcium abnormalities diagnosed?
- Our team evaluates calcium status with both blood and urine tests. In addition to that, we typically do ultrasounds of the neck. For hyperparathyroidism, patients will usually receive additional testing that is specific for localizing the parathyroid gland that has hypertrophied and they will also have bone density evaluation and a kidney ultrasound performed to assess for sequelae of hyperparathyroidism.

What is the treatment for hypoparathyroidism?
- Treatment for hypoparathyroidism typically involves aggressive calcium and Vitamin D supplementation as well as bone density monitoring.