8: Disorders of bone and mineral other than osteoporosis.
Rickets in children and osteomalacia in adults are caused by undermineralisation of bone, which increases its susceptibility to bending and fracture; treatment is with calcium, vitamin D or phosphate, depending on the specific mineral or vitamin deficiency. In Paget's disease, osteoclasts are overactive and produce woven or "repair" bone, which is mechanically weaker than lamellar bone; treatment is with antiresorptive bisphosphonate drugs. Cancers can produce bone lysis through direct spread within the skeleton or production of endocrine parathyroid hormone-like factors; treatment is with a bisphosphonate, plus appropriate therapy for the cancer. Cancer can also produce hypercalcaemia if the capacity of the kidneys to excrete the calcium dissolved from bone is exceeded; treatment is with saline infusion to increase excretion and a bisphosphonate. Primary hyperparathyroidism is the other common cause of hypercalcaemia and is usually associated with a single parathyroid adenoma; it is best treated with parathyroidectomy. Hypocalcaemia may result from severe decrease in calcium absorbed or lack of parathyroid action; both are treated with calcium and vitamin D (ergocalciferol or calcitriol). These disorders range from nutritional deficiencies to complex genetic and metabolic diseases
Prince
Richard L
RL
Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia. rlprince@cyllene.uwa.edu.au
Glendenning
Paul
P
D000328:Adult; D015519:Bone Density / Q000502:physiology*; D001847:Bone Diseases / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D001842:Bone and Bones / Q000473:pathology / Q000503:physiopathology; D002118:Calcium / Q000097:blood; D002648:Child; D006801:Humans; D010024:Osteoporosis / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy
D002118:Calcium