Metabolic bone disorders involve disease affecting the bones and also disease affecting calcium and phosphorous homeostasis
Bone is a dynamic tissue in which there is constant bone formation and resorption. One of the main disorders affecting the bones include Osteoporosis which is quite common. Other less common disorders include Osteopetrosis, Osteosclerosis, Osteogenesis Imperfecta etc.

Osteoporosis

Osteoporosis is characterized by decreased bone mass and micro-architecture disruption of the bone leading to increase risk of fragility fractures.
1 in 3 females and 1 in 5 males suffer an osteoporotic fracture in their lifetime. Early diagnosis and treatment prevents morbidity

Symptoms

Osteoporosis as such is an asymptomatic disease. But when a trivial fracture or microfracture occurs there may be localized pain, deformity and decrease in height.

Diagnosis

  • Trivial Fracture - When someone has a fracture of wrist, spine, hips, pelvis, ribs or humerus with only a minimal trauma it is most probably a pathological fracture.
  • DEXA scan - It can be done in elderly and those in whom osteoporosis risk is high. A T Score ≤-2.5 is classified as Osteoporosis and T score between -1.0 to -2.4 is classified as Osteopenia (Low bone mass)

Whom All To Screen

  • Age more than 65 years
  • Use of drugs like steroids, seizure medicines, immunosuppresants like cyclosporine etc
  • Endocrine disorders like Diabetes, Hyperparathyroidism, Hyperthyroidism , Hypogonadism etc
  • Gastrointestinal disease like coeliac disease, inflammatory bowel disease, chronic liver disease, pancreatic disorders etc
  • Rheumatological conditions like Rheumatoid arthritis, SLE , Ankylosing spondylitis etc

Treatment

This involves the use of Calcium and Vitamin D( If deficient) along with
  • Bone forming agents like Teriparatide OR/AND
  • Bone Resortion inhibitors like bisphosphonates and Denosumab
Treatment of Asymptomatic Osteoporosis as well as those who have had an Osteoporotic fracture is important as it prevents new and recurrent fractures. This reduces the overall morbidity and mortality of the patient.

Disorders of Calcium and phosphorous

These disorders affect bone health and include
  1. Hypercalcemia( high calcium levels)- These are commonly due to parathyroid disorders like parathyroid adenoma. Other causes include Vitamin D excess, certain drugs like lithium, vitamin A toxicity, Certain familial inherited syndromes like MEN 1 etc
  2. Hypocalcemia( Low calcium ) – This is commonly due to inadvertent parathyroid damage during thyroid surgery. Other causes can include hypoparathyroidism and certain inherited syndromes like Polyglandular syndromes.
  3. Hypophosphatemia( Low Phosphate in blood). This includes tumors which secrete excess FGF 23 ( Tumor Induced Osteomalacia),  certain Inherited Hypophosphatemic rickets, Proximal renal tubular diseases etc

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