Metabolic Bone
Diseases
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Definition of Metabolic bone disease
Metabolic bone disease is a weakening of the bones caused by
abnormal levels of the bone’s “building blocks,” such as
calcium, phosphorus or of vitamin D or minerals that support
the growth and strength of the bones.
Diseases or conditions that cause deficiencies in any of these
things can lead to bone loss, fragile bones, fractures, bone
deformities and serious disability.
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Types Metabolic bone diseases
Metabolic bone diseases include
osteoporosis,
osteomalacia (rickets) ,
renal osteodystrophy and
hyperparathyroidism.
These conditions can cause weakened bone, loss
of bone, frequent fractures or delayed growth in
children.
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Osteoporosis
Osteoporosis is a metabolic bone disease.
Some bone loss may occur in older adults over
time due to hormonal changes and aging, but
factors such as decreased estrogen in women, a
family history of the condition, small bones, poor
diet, excessive alcohol use and smoking can
weaken bones and worsen osteoporosis.
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Osteomalacia
Osteomalacia, sometimes called rickets, causes weak
or softened bones in children from a lack of sufficient
calcium or phosphorus.
Vitamin D allows the body to absorb these minerals to
help bones grow and maintain bone strength.
A vitamin D deficiency can result from poor diet, lack
of sunlight or an inability to absorb the vitamin
because of an intestinal condition such as celiac
disease, medications or an inherited disorder.
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Renal Osteodystrophy
Renal osteodystrophy is a bone disease that occurs in
adults and children with chronic kidney disease.
Renal osteodystrophy is a complication of chronic kidney
disease that weakens the bones.
It is caused by changes in the levels of minerals and
hormones in the blood. The main signs are bone pain and
fractures. There's no cure except for a kidney transplant.
Dietary changes, medications and surgery can slow its
progression.
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The kidneys help regulate mineral levels of calcium and
phosphorus in the blood.
They also produce calcitriol hormone by activating vitamin D to
keep the bones strong and healthy.
When the kidneys fail or aren’t functioning as well, they can’t
maintain proper levels of these minerals and calcitriol
hormone.
This can weaken your bones and lead to fractures.
Bone growth occurs during childhood. As an adult, the bones
are in a constant state of turnover and renewal. Old bone
tissue breaks down and new tissue replace it.
Renal osteodystrophy can occur when bone turnover is too fast
or too slow.
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Types of renal osteodystrophy?
The four main types of renal osteodystrophy include:
Osteitis fibrosa: Bone tissue breaks down too fast and leads to
higher-than-normal levels of parathyroid hormone
(hyperparathyroidism).
Osteomalacia: Bone tissue breaks down but new bone doesn't
form, leaving it spongy and weak. Osteomalacia can cause low
levels of vitamin D, heavy metal toxicity and overproduction of
FGF23 by certain cancers.
Adynamic bone disease: Bone tissue doesn't renew itself as it
should. This condition is the result of lower levels of parathyroid
hormone.
Mixed renal osteodystrophy: Includes signs of osteitis fibrosa
and osteomalacia.
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Parathyroid Problems and Bone Disease
Conditions of the parathyroid glands can lead to bone
disorders. The parathyroid glands are small glands located in
the neck. They produce parathyroid hormone, or PTH.
The function of PTH is to regulate calcium and phosphorus in
the blood, which are both essential to bone health.
When a problem affects the function of the parathyroid glands,
lack of these minerals can cause the bones to become weak,
fragile or deformed.
The parathyroid diseases that can affect the mass and
structure of the bones include:
Parathyroid tumor
Primary or secondary hyperparathyroidism, which can be caused
by:
Previous head and neck radiation treatments
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Use of lithium medications
Causes of Metabolic Bone Disease
Metabolic bone disease can affect anyone, but are more likely to occur in people who:
Have a vitamin D deficiency
Are older (except osteomalacia, which affects children)
Have a small body size
Have kidney disease
Do not get much sunlight, which provides vitamin D
Have had organ transplants
Have been treated with hormones for prostate cancer or breast cancer
Experience menopause before age 45
Have a medical condition that prevents absorption of vitamin D
Smoke
Take steroids
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Causes of Metabolic Bone Disease ctnd
Drink alcohol excessively
Metabolic Bone Disease Symptoms
People with metabolic bone disease may experience:
Aching bones, especially in the back, hips and legs
Delayed growth (in children)
Curving of the spine
Tooth problems
Loss of height due to compression of vertebrae (bones of the spine)
Knees that bow outward or “knock” knees that bend inward
Frequent fractures, especially:
Those occurring in people over 55
Those caused by falls from a standing height or less, which can indicate abnormally fragile bones
Fragility fractures (breaking a bone when falling from standing height of less) that occur after
menopause or in older men should not be thought of as a normal part of aging. When this happens, a
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doctor should evaluate the person for metabolic bone disorders, including bone density testing.
Symptoms of Metabolic Bone Disease
People with metabolic bone disease may experience:
Aching bones, especially in the back, hips and legs
Delayed growth (in children)
Curving of the spine
Tooth problems
Loss of height due to compression of vertebrae (bones of the spine)
Knees that bow outward or “knock” knees that bend inward
Frequent fractures, especially:
Those occurring in people over 55
Those caused by falls from a standing height or less, which can indicate abnormally fragile bones
Fragility fractures (breaking a bone when falling from standing height of less) that occur after
menopause or in older men should not be thought of as a normal part of aging. When this happens, a
doctor should evaluate the person for metabolic bone disorders, including bone density testing.
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Diagnosis of Metabolic Bone Diseases
Identifying the cause of weakened bones helps the doctor recommend the
best possible treatment.
Some of the tests that help diagnose metabolic bone disease include:
Blood tests: These include measurements of calcium, phosphorus, vitamin D
and parathyroid hormone. Blood tests can also measure other markers, such
as alkaline phosphatase, that help with bone turnover (regeneration). In
chronic kidney disease, blood tests will be performed routinely to look for
changes in these levels.
DEXA (dual energy X-ray absorptiometry) scan-A bone density scan, also
called DEXA, uses an X-ray to measure the bone mineral content and density.
A DEXA scan produces more detailed images than a standard X-ray and helps
to identify fragile bones before they break. A DEXA measures the bone
density of spine, pelvis, lower arm and thigh.
Scans of the parathyroid glands, such as CT, ultrasound or MRI
Bone biopsy: A biopsy involves collection of a small sample of tissue for
laboratory analysis. Bone biopsies can help to check bone density and
structure, but they're rarely used.
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Treatment/Medications for Metabolic Bone Disease
Depending on the root cause of the bone loss, Metabolic Bone Disease
may treat the problem by prescribing:
Dietary changes:
low phosphorus diet. This includes limiting processed and packaged
foods which are often high in added phosphorus.
limit foods that have naturally high levels of phosphorus if you have
advanced kidney disease.
Parathyroid hormone
Estrogen
Biophosphonate medications
Calcitonin
Denosumab injections
Vitamin D and calcium supplements
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Other Treatments
If the bone disease is due to a parathyroid tumor,
treatment such as surgery (parathyroidectomy) or
radiation may be recommended, depending on
whether the tumor is benign (noncancerous) or
malignant (cancerous).
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