Clinical Question About Bone Disease

  1. 0
    Hi all, I'm working on some clinical questions for my A&P class. It's all going well, except for one question I'm not sure about. We never went over diseases in class, so I'm slightly lost.

    Here's the question
    4. Gina is 67 years old and a test shows she has reduced bone density, but she has a normal level of [Ca2+] plasma levels. After taking a survey of her friends of similar age, Gina notices her female friends suffer from this reduced bone density at a larger rate compared to her male friends. What is the bone disorder that Gina has and why is it more prevalent in female friends at her age? Be sure to explain what is occurring at the level of the bone. Why are Gina’s [Ca2+]plasma levels normal? What are some possible treatments that the doctor may suggest to help Gina with her reduced bone density?
    The bolded part is the only one I'm not sure of. It seems that this is osteoporosis, but I thought with that calcium levels should be lower, not normal. Any suggestions?

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  2. 4 Comments...

  3. 1
    It is Osteoporosis. In an older woman as hormone levels change the Osteoblast activity slows down while Osteoclast activity slightly out paces it. Net result = decreased bone density. This isn't likely an issue of low bone density because of low calcium. The cells inside the bones themselves are not using the CA2+ in the blood like they used to............

    If you have more questions just ask

    PS-If your blood calcium levels are low, the body will "steal' calcium from the bones FYI
    This appears to be a classical case of osteoporosis in an older woman. You could clinically correlate with asking her about her diet, and also checking thyroxine (T3-T4) to see if hormones are off. Maybee even a CBC for good measure
    sergel02 likes this.
  4. 1
    Your calcium levels need to stay in a normal range. The body is constantly using different mechanisms to keep all sorts of levels normal. Your potassium, sodium, chloride, and calcium all have to stay in a very specific range or bad things happen. One way the body keeps calcium levels normal is to leach calcium from the bone. As the blood requires this calcium to stay at a specific level, more and more is leached out of the bone...leading to osteoporosis. The easiest way to combat this to provide oral calcium to fill the levels...and the bone won't have to provide it. (And then you can get into all the prescription medications that raise calcium levels, but that's down the road). If someone is malnourished, the bone density goes down until they can properly take in oral calcium from food. No matter what, your blood levels are going to try to keep your calcium level in a specific range, even if the rest of your body suffers.

    Another thing they can do is take oral Vitamin D. When you take vitamin D, it causes the gut to absorb more calcium, instead of it passing through. Most women who have to take calcium pills usually have to take vitamin D as well. If not, calcium is not absorbed as well as it can.

    However, this scenario doesn't have me fully convinced that this lady has osteoporosis. This sounds more like Osteopenia to me. Osteopenia is a lesser form of osteoporosis. With osteoporosis, the bone has hollowed out...the same way a sponge looks and the cells are eating away at itself. But someone who simply has a decreased bone density would qualify them as having osteopenia. And that would explain the calcium, because the disease is not as advanced. The calcium requirement isn't that high yet, but the density has started dropping. Not every person who has decreased bone density has osteoporosis....that is advanced bone destruction. I think this women has ostepenia. Actually, the definition of Osteopenia is a bone density of -1 to -2.5.

    There is a specific reason it happens more in women. Hormone levels begin to drop after menopause and that leads to osteopenia and osteoporosis. Mainly estrogen. Taking estrogen can help with bone density loss. Men have less issues with it because testosterone increases bone density. When men age, the testosterone level drops, and then they become at risk. Testosterone supplementation can help with this. Even women have undergone low-dose testosterone supplementation to fight off osteoporosis. Then there's the parathyroid, which regulates calcium, but that's a whole other component with different processes. Hope this helps!
    sergel02 likes this.
  5. 0
    Quote from DCtooRN
    It is Osteoporosis. In an older woman as hormone levels change the Osteoblast activity slows down while Osteoclast activity slightly out paces it. Net result = decreased bone density. This isn't likely an issue of low bone density because of low calcium. The cells inside the bones themselves are not using the CA2+ in the blood like they used to............

    If you have more questions just ask

    PS-If your blood calcium levels are low, the body will "steal' calcium from the bones FYI
    This appears to be a classical case of osteoporosis in an older woman. You could clinically correlate with asking her about her diet, and also checking thyroxine (T3-T4) to see if hormones are off. Maybee even a CBC for good measure
    Thanks for the help! I know I'm replying late, but this helped a lot, and made it very clear.

    Quote from hodgieRN
    Your calcium levels need to stay in a normal range. The body is constantly using different mechanisms to keep all sorts of levels normal. Your potassium, sodium, chloride, and calcium all have to stay in a very specific range or bad things happen. One way the body keeps calcium levels normal is to leach calcium from the bone. As the blood requires this calcium to stay at a specific level, more and more is leached out of the bone...leading to osteoporosis. The easiest way to combat this to provide oral calcium to fill the levels...and the bone won't have to provide it. (And then you can get into all the prescription medications that raise calcium levels, but that's down the road). If someone is malnourished, the bone density goes down until they can properly take in oral calcium from food. No matter what, your blood levels are going to try to keep your calcium level in a specific range, even if the rest of your body suffers.

    Another thing they can do is take oral Vitamin D. When you take vitamin D, it causes the gut to absorb more calcium, instead of it passing through. Most women who have to take calcium pills usually have to take vitamin D as well. If not, calcium is not absorbed as well as it can.

    However, this scenario doesn't have me fully convinced that this lady has osteoporosis. This sounds more like Osteopenia to me. Osteopenia is a lesser form of osteoporosis. With osteoporosis, the bone has hollowed out...the same way a sponge looks and the cells are eating away at itself. But someone who simply has a decreased bone density would qualify them as having osteopenia. And that would explain the calcium, because the disease is not as advanced. The calcium requirement isn't that high yet, but the density has started dropping. Not every person who has decreased bone density has osteoporosis....that is advanced bone destruction. I think this women has ostepenia. Actually, the definition of Osteopenia is a bone density of -1 to -2.5.

    There is a specific reason it happens more in women. Hormone levels begin to drop after menopause and that leads to osteopenia and osteoporosis. Mainly estrogen. Taking estrogen can help with bone density loss. Men have less issues with it because testosterone increases bone density. When men age, the testosterone level drops, and then they become at risk. Testosterone supplementation can help with this. Even women have undergone low-dose testosterone supplementation to fight off osteoporosis. Then there's the parathyroid, which regulates calcium, but that's a whole other component with different processes. Hope this helps!
    Wow thanks for the thorough explanation. I was thinking maybe osteopenia, but i ended up sticking with osteoporosis has it seemed more likely from what I read. Of course, i can't tell without doing some tests or anything.

    About your last point though, while men also experience bone loss, they don't have any sort of experience like menopause, which is why their bone loss is less. Is that correct?
  6. 0
    Quote from sergel02
    About your last point though, while men also experience bone loss, they don't have any sort of experience like menopause, which is why their bone loss is less. Is that correct?
    Yes! In menopause, hormones drop significantly, where as with men, they slowly have their testosterone levels drop, bit by bit, as the years go by. Plus, think of testosterone as being very potent. There would have to be a significant loss of testosterone to induce advanced osteoporosis in men(along with having very low estrogen levels to begin with). Unfortunately, women have to experience a massive change all at once (along with having very low testosterone levels throughout life). Men and women both have testosterone and estrogen in their bodies, and without one or the other, that's when things start going downhill.


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