ASAP Live Session: Bone & Parathyroid Disorders - Thursday, June 22, 2023: 7:00-8:00 pm ET-Slides

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The ASAP Live session on Bone & Parathyroid Disorders took place on Thursday, June 22, 2023, and was led by Elias S. Siraj, MD, and Geetha Gopalakrishnan, MD. The session covered various topics related to bone and parathyroid disorders.<br /><br />Case 1 discussed a 55-year-old woman with persistent hyperparathyroidism after parathyroidectomy. Her recent serum calcium level was slightly low, and her parathyroid hormone (PTH) level was elevated. She had osteoporosis and had been taking alendronate but experienced a decline in bone mineral density. She also had cognitive concerns, fatigue, and other symptoms. Based on her history and laboratory results, the most important test to perform was a 24-hour urine calcium and creatinine test. The finding of low urinary calcium suggested secondary hyperparathyroidism due to malabsorptive celiac sprue.<br /><br />Case 2 involved a 57-year-old man with recurrent insufficiency fractures. He had hypophosphatemia and elevated alkaline phosphatase, and his bone mineral density showed low T-scores. The most appropriate next step in the evaluation was to measure fibroblast growth factor 23 (FGF23) levels to determine if he had a genetic disorder or other cause of secondary hyperparathyroidism.<br /><br />Case 3 featured a 73-year-old woman with multiple vertebral compression fractures. She had been on denosumab but stopped treatment and subsequently developed new fractures. The recommended management option was to initiate zoledronic acid 6 months after the last denosumab injection to prevent further fractures.<br /><br />Case 4 discussed an 18-year-old woman residing in a refugee camp with muscle weakness and bone pain. She had low dietary intake of vitamin D and calcium and limited access to sunlight. The expected laboratory findings in this individual would include low calcium, low phosphorus, and elevated parathyroid hormone (PTH) and alkaline phosphatase levels.<br /><br />Case 5 involved a 72-year-old woman with stage 3b chronic kidney disease (CKD) and postmenopausal osteoporosis. She had a recent fracture while taking alendronate. The expected bone turnover markers in this patient would include elevated bone-specific alkaline phosphatase and elevated serum β-C-terminal telopeptide.<br /><br />Case 6 concerned a 47-year-old woman with polymyalgia rheumatica treated with prednisone who sustained a spine fracture. The next best step in her bone health management would be to start oral alendronate as a first-line treatment for glucocorticoid-induced osteoporosis.<br /><br />Overall, the ASAP Live session provided clinical scenarios and discussed the appropriate diagnostic and management steps for various bone and parathyroid disorders.

Keywords

ASAP Live session

Bone & Parathyroid Disorders

hyperparathyroidism

osteoporosis

alendronate

insufficiency fractures

fibroblast growth factor 23

denosumab

chronic kidney disease

glucocorticoid-induced osteoporosis