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ngaybinhyen
Forum Guru

Topics: 23
Posts: 657
09/26/08 - 09:09 AM       #1

A 48-year-old woman presents with right hip pain after slipping on her kitchen floor. In addition, she has had diffuse weakness and malaise for 3 years. She complains of difficulty swallowing and dry eyes. She denies any other symptoms. She is perimenopausal and does not take any medication. The patient denies any significant past medical history. A radiograph of the hip shows a fracture of the right femoral neck. On physical exam, there is decreased salivation. Palpation of her bones elicits a dull pain. Laboratory data are:
White blood cells: 8.000/mm3
Hematocrit: 37%
Platelets: 220.000/mm3
Sodium: 140 mEq/L
Potassium: 2.9 mEq/L
Chloride: 117 mEq/L
Bicarbonate: 13 mEq/L
Urea nitrogen: 15mg/dL
Creatinine: 0.9 mg/dL
Phosphate: 2.8 mg/dL
Calcium: 9 mg/dL
Anti-Ro antibodies: 500 U/mL (normal: <25 U/mL)
Anti-La antibodies: 300 U/mL (normal: <25 U/mL)
What is the MOST likely etiology of her of fracture?
O A. Decreased bone density
O B. Decreased bone mineralization
O C. Diffuse metastatic disease to bones
O D. Gastrointestinal phosphate loss
O E. Primary hyperparathyroidism

Eagle_303
Forum Guru

Topics: 77
Posts: 655
09/26/08 - 12:15 PM       #2

SJS ------- > RTA type 1 ----------> Osteoporosis

Any chronic acidotic condition leads to demineralization of the bones and then ostoeporosis


docnit
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Topics: 8
Posts: 193
09/26/08 - 12:21 PM       #3

absoutely correct! nod

ngaybinhyen
Forum Guru

Topics: 23
Posts: 657
09/26/08 - 01:00 PM       #4

Osteomalacia: defect in bone mineralization, can be caused by persistent acidosis or defects in osteoid formation. Bone mineralization requires adequate osteoid formation, calcium, phosphate, a normal serum pH and adequate alkaline phosphatase activity
-->serum chemistry abnormalities
- Frequently seen in patients who also have osteoporosis
- Elderly are at particularly high risk
- May present with malaise, bone pain, or muscle weakness
- Abnormalies of serum calcium, phosphate, vitamin D, bone alkaline phosphatase, and/or urinary calcium are usually present
- Pseudofractures (or Looser's zone or Milkman fractures) on X-ray; may see compression deformities in vertebrae


Osteoporosis: defect in bone density
- Can present as acute fracture of vertebral body, femur, or wrist
- Osteopenia seen on X-rays

Eagle_303
Forum Guru

Topics: 77
Posts: 655
09/26/08 - 01:05 PM       #5

Yes brother I agree with you .

I stand corrected .Chronic acidotic conditions cause osteomalacia not osteoporosis.

I came to know after I posted my reply.Thanks for correction.




ngaybinhyen
Forum Guru

Topics: 23
Posts: 657
09/26/08 - 01:12 PM       #6

wink

docnit
Forum Senior

Topics: 8
Posts: 193
09/26/08 - 01:22 PM       #7

please chek goljan pathology ( 340 pgs book) the patholgy review one page number: 52 under the section of Distal RTA.

Osteoporosis is correct (bone buffers excess H ions)

nightflight1945
banned

Topics: 32
Posts: 920
09/26/08 - 02:04 PM       #8

smiling face


Eagle_303
Forum Guru

Topics: 77
Posts: 655
09/26/08 - 02:41 PM       #9

docnit wrote:
please chek goljan pathology ( 340 pgs book) the patholgy review one page number: 52 under the section of Distal RTA.

Osteoporosis is correct (bone buffers excess H ions)


OMG !!!

What to say ??

Robins pathology does not enlist RTA as a cause of osteoporosis while Goljan does.

Harrison does not enlist RTA as a cause of osteoporosis while Cecil's medicine does .

Where to go ??? shockedshockedraised eyebrowraised eyebrowsticking out tonguesticking out tonguesticking out tongue


docnit
Forum Senior

Topics: 8
Posts: 193
09/26/08 - 03:03 PM       #10

very interesting!!! smiling face

then the only clue to know which books the question setter has in mind is to see the lab values!

low phosphate normal calcium ( chronic RTA) : osteomalacia
osteoporosis: high/low calcium depends on the cause , phosphate : normal.

so the question setter has read harrison and robin's !!!
feel bad for my fav goljan sad sticking out tongue









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