Osteoporosis & Other Metabolic Bone Disorders
Osteoporosis is a chronic medical condition characterized by low bone mass and abnormal microarchitecture that increases the risk for low trauma and nontraumatic fractures. This disorder affects mostly both men and women over age 50 but not only. Younger patients can have this problem too. If you sustain a ground level fall that results in breaking of any bone except fingers, toes and facial bones then you are diagnosed with osteoporosis.
In addition to diet and exercise, there are many drug therapies available for prevention and treatment of osteoporosis for both females and males but it is very important to first exclude other disorders that can interfere with the bone metabolism before starting any treatment. The treatment sequence is also very important and that’s why you need to be guided by physicians experienced in osteoporosis treatment like Dr Stanciu.
Osteopenia
Osteopenia is both a clinical and a radiological term. It means that the bone mass or density has declined and it is no longer in the “normal” range. Sometimes a patient never achieved a “normal” bone density due to many reasons. If you have a bone density test that shows osteopenia, it should alert you to look into it in order to prevent osteoporosis, low trauma fractures or have difficulty healing after bone surgery. Make an appointment now to see if you are at risk.
Abnormal Bone Density Test (DXA)
A bone mineral density test (also called DXA scan) is a measurement of how much mineral is in your bone or how dense is your bone. This test uses a special X-ray technique (with much less radiation than a usual X Ray) to measure bone mineral density. It is used to screen for osteoporosis (that means to find out if a person has osteoporosis before breaking a bone). It is also used to monitor the osteoporosis treatment. Dr Stanciu is certified to perform and interpret bone mineral density tests. She is a Certified Clinical Densitometrist (CCD) – title conferred by ISCD (The International Society for Clinical Densitometry) after rigorous training and examination.
Do you know if your bone density is normal? Make an appointment to find out.
Vitamin D Deficiency
Vitamin D deficiency is a very common condition. No matter what your age is, if the level of vitamin D in your blood is low, your bones will not be mineralized and will be soft, fragile or misshapen. But vitamin D is important for ALL cells in your body and insufficient levels are associated with many disorders (outside of the bone metabolism) like cancers, infections and others. Even though exposure to sunshine can help your skin produce vitamin D, the location where you live (altitude and latitude), skin conditions, other disorders (for example liver disease) can interfere with absorption and metabolism of the vitamin D and your blood vitamin D level may be insufficient.
You need to have your blood levels for vitamin D checked periodically and if they are low you will require vitamin D treatment. If you take high dose vitamin D (more than 2000 units daily) without checking the blood levels you can develop vitamin D intoxication. Make an appointment with Dr Stanciu to find out your vitamin D status.
Parathyroid Disorders
Parathyroid disorders (overactive = hyperparathyroidism and underactive = hypoparathyroidism) are disorders that affect many organs including bones and kidneys and are characterized by abnormal levels of calcium in the blood.
There are 3-6 parathyroid glands (majority of people have four glands). They are located in the back of the thyroid gland (one in each corner) but sometimes they are located in other places in the neck or even in the upper part of the chest (called mediastinum). The role of parathyroid glands is to maintain normal blood calcium at all times (and within a very narrow range) independent of how much you receive from diet or how much you absorb from the intestine.
Maintaining normal blood calcium level is of paramount importance as an abnormal level (too low or too high) of blood calcium can immediately impair the heart function and be life threatening. If your blood calcium is too low or too high or if you have low trauma fractures or kidney stones then you should be evaluated for parathyroid dysfunction. Call Dr Stanciu and make an appointment today.
Thyroid and Parathyroid Ultrasound
Dr Stanciu is ECNU-certified in performing and interpretation of thyroid, parathyroid and neck ultrasound studies as well as thyroid, parathyroid and lymph node biopsies. ECNU stands for Endocrine Certification in Neck Ultrasound and it is a certification provided by AACE (American Association of Clinical Endocrinology) after rigorous training and examination.
Ultrasound is a non-invasive and non-painful imaging test that can be easily done in the office by Dr Stanciu herself. Using ultrasound waves, the thyroid, parathyroid and lymph nodes of the neck can be imaged so proper evaluation of your condition can be done and adequate treatment can be recommended.
Thyroid, parathyroid and lymph node biopsies are not offered at this time but stay tuned as they will be added soon.
Make an appointment today for a thyroid, parathyroid and neck ultrasound.
Osteomalacia (soft bone)
Osteomalacia is a mineralization disorder found in adults (kids can have it too but it is called “rickets”) in which bones become soft and deformed because they don’t have enough calcium, vitamin D and/or phosphorus. This condition may be genetic or acquired (due to dietary deficiency, intestinal disorders that impair absorption of minerals and vitamins as well as intestinal surgeries or other chronic medical conditions). Check with Dr Stanciu if you have adequate calcium and vitamin D intake to make sure you do not develop “soft bones”. Adequate treatment will restore bone mineralization and will reduce risk for fractures.
Osteogenesis Imperfecta (also called “brittle bone disease”)
Osteogenesis Imperfecta is a genetic disorder that mostly presents in childhood with bone deformities and multiple fractures. Sometimes may be minimally symptomatic in childhood and not be diagnosed until adult age. In this disorder there is a genetic defect responsible for abnormal collagen production. Because of this collagen abnormality, the bones are soft and can break easily. This results in multiple fractures that occur without apparent cause. If you have many fractures without trauma you may have a genetic mutation that makes your bones brittle. Find out if you are at risk. Call for an appointment today.
Hypophosphatasia HPP
Hypophosphatasia (HPP) is a rare (but not so rare) genetic disorder characterized by abnormal mineralization of bones and teeth but for a different reason than osteomalacia. In HPP the bone enzyme called alkaline phosphatase is abnormal or dysfunctional due to a genetic abnormality. Even though the most severe cases are found in infants and children, the mild cases can be difficult to diagnose until adulthood and very frequently can be misdiagnosed as other disorders like fibromyalgia, chronic fatigue, depression, chronic headaches, etc. Many adults don’t know they have this condition, which will predispose to many fractures without trauma, but also other symptoms like diffuse body pain, headaches, muscle weakness, fatigue, kidney stones, joint pain, teeth problems/losing teeth. Life-saving treatment is available!
X-linked Hypophosphatemia XLH
X-linked hypophosphatemia (XLH) is an inherited genetic disorder characterized by low phosphorus levels in the blood due to abnormal “wasting” of the phosphorus through the urine (due to elevated levels of a bone hormone called FGF-23). This leads to soft bones which are painful, easily deformed and prone to fractures. XLH is usually diagnosed in childhood (more severe cases) as bones are soft and deformed and children cannot walk or run and cannot grow normally. Deformities like “bowed legs” are evident and frequent fractures without trauma are common. Some cases are mild and sometimes missed or misdiagnosed as “rickets”. Other times patients have nonspecific (vague) symptoms like fatigue, weakness, bone pain, headaches, depression. With time, there is progressive and/or generalized weakness, inability to walk, increasing fatigue, bone pain and numerous fractures. Many adults are never diagnosed until they break a bone or they are found to have extreme weakness that requires assistance. This condition is now treatable as breakthrough medication is available.
Tumor Induced Osteomalacia TIO
This disorder is similar in presentation with XLH but it is not a genetic disorder. This is a rare but acquired (no genetic cause) bone disorder caused by renal phosphate wasting resulting in very low blood phosphorus, severe generalized weakness, body pain and fractures. Similar to XLH, these symptoms are produced by elevated levels of a hormone called FGF-23 which is produced by a small tumor (sometimes very hard to find) that can appear anywhere in the body. If found, the tumor may be surgically removed and in this care the disease is cured. Sometimes, despite extensive testing and localization modalities, the tumor cannot be found or can be located in areas inaccessible to surgery. For these cases, treatment is now available with life-saving medication. Find out how!
Fibrous Dysplasia FD
Fibrous dysplasia (FD) is a rare bone disorder that can affect one or more bones and sometimes can be associated with other hormonal disorders (like thyroid or adrenal abnormalities). The normal bone is replaced with abnormal fibrous tissue that weakens the bone and makes it fragile, easy to break and painful. Pain and deformities are sometimes presenting features. Fibrous Dysplasia is usually diagnosed in children or young adults, but mild cases may go undiagnosed until adulthood.
Paget’s Disease
Paget’s disease is another rare but chronic metabolic bone disorder characterized by excessive breakdown and regrowth of the bone. This abnormal process makes the bones soft, easily breakable and painful. It can affect one or several bones but its cause is not yet known. It is more common in older people (over age 50). Depending on the bones involved it can give symptoms like headaches, hearing loss, pressure on the nerves, damage of the cartilage in the joints, increase in size of the affected bone. Sometimes is asymptomatic and can be found because of an abnormally elevated blood test called alkaline phosphatase. Treatment is available to control the disease and maintain normal functionality.
Metabolic bone disorder due to chronic kidney disease
Patients with abnormal (decreased) kidney function will develop a specific bone disorder that increases the risk for low trauma fracture due to abnormalities in the bone structure, density and bone mineral. Chronic kidney disease is a progressive disease and can end up with need for dialysis. During kidney disease progression, abnormalities in calcium, phosphorus, FGF-23, proteins, vitamin D develop and will affect the bone tissue. You can prevent chronic kidney disease by avoiding nonsteroidal antiinflammatory medications, drinking more water and avoiding/controlling diabetes and hypertension disorders.
Any Calcium, vitamin D, phosphorus disorder
Abnormalities in the calcium, phosphorus and vitamin D metabolism can have many causes. Sometimes your diet is deficient or you become deficient after a surgical procedure (stomach and intestinal surgeries, etc) but other times you may have other disorders (kidney, liver, etc). It is important to have laboratory tests to monitor these minerals and vitamins so you are not deficient or have too much (intoxicated). A balanced level of these minerals and vitamins help you maintain good bones and good health.
Hypercalciuria is a condition in which excessive loss of calcium in the urine occurs which will contribute to kidney stones and weak, easy to fracture bones. It is very common in postmenopausal women. Sometimes it may be the result of another disorder (like primary hyperparathyroidism, hyperthyroidism, Paget’s disease, myeloma, immobilization, sarcoidosis, medications, excessive calcium intake). If none of these are present, then we call it idiopathic hypercalciuria. Dietary changes and treatment with a special class of diuretics (thiazides) will control this condition.