Calcium Metabolism

Phosphate metabolism

Renal Osteodystrophy
-Failure of kidney to maintain proper levels of calcium
and phosphorus in blood
-Common in kidney disease and dialytic patient
-Silent crippler and childhood
-Post-menopausal women
-Investigation:-Serum calcium and phosphorus level
-Parathyroid hormone level
-Calcitriol level
-Bone biopsy

-Treatment:-Cinacalcet hydrochloride
-Paracalcitol, Doxercalciferol, Alfacalcidol, Calcitriol

Osteitis Fibrosa Cystica

-Osteodystrophia fibrosa, Von Recklinghausens disease of bone
-Skeletal disorder caused by hyperparathyroidism
-Symptoms:- bone pain, fractures(arms, leg, spine), skeletal deformities
- kidney stones, nausea, constipation, fatigue, weakness
- LOA, LOW, vomitting, polyuria, polydipsia
-Signs:- Bulked up muscles
- Poor muscle contraction and relaxation
- Tracheal shift
-Causes:- Parathyroid Adenoma
- Hereditary Factors(Familial hyperparathyroidism, MEN I)
- Parathyroid carcinoma(HRPT 2 - parafibromin)
- Renal complication

Parameter/
Condition

Osteopenia

Osteopetro
sis

Osteomalac Osteitis
ia and
Fibrosa
rickets
Cystica

Calcium

Unaffected

Unaffected

Decreased

Elevated

Phosphorus

Unaffected

Unaffected

Decreased

Decreased

Alkaline
Phosphatase

Normal

Elevated

Elevated

Elevated

PTH

Unaffected

Unaffected

Elevated

Elevated

Comments

Decreased
bone mass

Marble bone

Soft bones

Brown tumor

-Management:Medical = Calcitriol and Alfacalcidol

Surgery = Parathyroidectomy
= 7 years life span, hypocalcemia