ENDOCRINE MODULE ASSIGNMENTS METABOLIC BONE DISORDERS
1) A 42-year-old lady with rheumatoid arthritis has been on corticosteroids for 2 years. She
presented to emergency department with back pain and radiological examination
showed crush fracture of her lower thoracic vertebrae. Biochemical investigations were
as follows:
Serum Analyte Reference range
Calcium 2.4 mmol/L 2.2 – 2.6
Phosphate 1.0 mmol/L 0.8 - 1.4
Alkaline Phosphatase (ALP) 170 U/L 30 - 150
a) Interpret the biochemical results and explain the abnormality.
b) State the most likely diagnosis.
c) State the investigation to confirm the diagnosis and its criteria for confirmation.
d) State the most likely cause for your diagnosis in this patient.
e) List three (3) other causes for the diagnosis stated in (c).
f) Describe the role of bone turnover markers (BTM) in osteoporosis.
g) State the first-line treatment for this condition.
2) A 50-year old man with end-stage renal failure complained of bone pain and tenderness.
Blood investigations showed:
Serum Analyte Reference range
Haemoglobin 9 g/dL 13 - 18
Sodium 135 mmol/L 135 - 145
Potassium 5.5 mmol/L 3.6 – 5.0
Urea 43 mmol/L 3.3 – 6.7
Creatinine 670 µmol/L 60 - 120
Phosphate 2.43 mmol/L 0.8 - 1.4
Calcium 1.93 mmol/L 2.2 – 2.6
Alkaline Phosphatase (ALP) 207 U/L 30 - 150
Parathyroid hormone (PTH) 150 g/L 10 - 65
a) Explain the following laboratory results:
The reduce in serum haemoglobin, increased creatinine, and urea is consistent with the
patient’s kidney condition. Mineral and bone disorder in CKD occurs when damaged kidneys and
abnormal hormone levels cause calcium and phosphorus levels in a person’s blood to be out of
balance. Mineral and bone disorder commonly occurs in people with CKD and affects most people
with kidney failure receiving dialysis.
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