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ENDOCRINE SYSTEM
689
Management of hypoparathyroidism may consist of any of the
foliowing8.'J .• 7:
•
Dietary modifications that promote a diet high in calcium and
low in phosphate
•
Pharmacologic intervention with the following:
PTH
Vitamin 0 supplements: dihydrotachysterol (Hytakerol),
dihydroxycholecalciferol, or ergocalciferol (Calciferol) (vitamin 0,)
Nutritional supplements: calcium gluconate, calcium glubionate, calcium lactate, or calcium chloride
Metabolic 80l/e Disorders
Osteoporosis
Osteoporosis is a multifactorial skeletal disotder that leads to
decreased bone density and organization, which ultimately reduces
bone strength." Bone strength is often measured by bone mineral
density studies, which are used in the diagnosis of osteoporosis, as
well as moniroring rools for therapeutic improvements. Osteoporosis
can be classified a primary or secondary. Primary osteoporosis can
occur in both genders at all ages, but often follows menopause in
women and occurs later in life in men. Secondary osteoporosis is a
result of medications (e.g., glucocorticoids or anticonvulsants), alcoholism, other conditions (e.g. , hypogonadism or hypoestrogenism), or diseases (e.g., hyperthyroidism)."
There is no clear etiology for osteoporosis. However, many risk
factors for women have been elucidated. These risk factors include
white or Asian racc, petite frame, inadequate dietary intake of calcium, positive family history of osteoporosis, alcohol abuse, cigarette smoking, high caffeine intake, sedentary lifestyle, reduced bone minerai coment (most predictive factor), and early menopause or oophorectomy (ovary removal).1.·7 .• ,
Signs and symptoms of osteoporosis may include the
followingl.'7:
•
Back pain (aggravated by movement or weight bearing, relieved
by rest)
•
Vertebral deformity (kyphosis and anterior wedging)
690
ACUTE CARE HANDBOOK FOR I)HVSICAI. THERAPIST'S
•
Presence of vertebral compression fractures, Calles' fracture, hip
and pelvic fractures
Management of osteoporosis may consist of any of the
foliowingJ,49.50:
•
Daily supplementation with calcium and vitamin D for all women
with low bone mineral density
•
Hormone replacement therapy with estrogen or estrogen combined with progesterone
•
Estrogen receptor modulation therapy with raloxifene hydrochloride
•
Bisphosphonate supplementation (inhibits bone resorption) with
alendronate sodium or risedronate sodium
•
Calcitonin supplementation (increases total body calcium)
•
Physical therapy for exercise prescription
•
Fracture management (if indicated, refer to Chapter 3)
•
Administration of PTH (in research stages)
Clinical Tip
•
Always consult with the physician to determine whether
there are any weight-bearing precautions in patients with
osteoporosis.
•
An abdominal corset can provide additional support for
stable vertebral compression fracture(s).
•
Also, using a rolling walker that is adjusted higher than
normal can promote a more upright posture. Both of these
techniques may also help to decrease back pain in patients
with osteoporosis.
•
Gentle exercises to improve the strength of thoracic
extensors can also a sist with posture and reduce back
pain.
•
Caution with resistive exercises and manual contacts
should be taken during therapeutic activities to avoid risk
of microtraurna or fracture to osteoporotic bones.
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691
Osteomalacia
Osteomalacia, or rickets in children, is a disorder characterized by
decreased bone mineralization, reduced calcium absorption from the
gut, and compensatOry hyperparathyroidism. The etiology of osteomalacia stems from any disorder that lowers serum levels of phosphate, calcium, or vitamin 0.11•47
Signs and symptOms of osteomalacia may include the following".47:
•
Bone pain and tenderness
•
Softening of cranial vault (in children)
•
Swelling of costOchondral joints (in children)
•
Predisposition to femoral neck fractures (in adults)
•
Proximal myopathy
•
Waddling gait
Medical management of osteomalacia may consist of treating the
underlying or predisposing condition or supplementation with calcium and vitamin 0.11•51
Paget's Disease
Paget's disease is a bone disease of unknown etiology that usually presents after the age of 55 years. The primary feature is thick, spongy bone that is unorganized and brittle as a result of excessive osteoclastic and subsequent osteoblastic activity. Some evidence points to an inflammarory or viral origin. Fractures and compression of the cranial
nerves (especially the eighth nerve) and spinal cord are complications
of Paget's disease.47,52
Paget's disease is generally asymptomatic; however, the following
clinical manifestations may present4 7•52:
•
Bone pain that is unrelieved by rest and persists at night
•
Bone deformity (e.g., skull enlargement, bowing of leg and
thigh)
•
Increased warmth of overlying skin of affected areas
•
Headaches or hearing loss
Management of Paget's disease consists primarily of bisphosphonate administration (oral etidronate, alendronare, tiludronare, rised-