Many Medical College of Wisconsin physicians may be involved in the care of calcium, parathyroid and metabolic bone disorders. Medical College of Wisconsin endocrinologists have experience and expertise in managing and treatment in these disorders, which include osteoporosis, hyperparathyroidism, Paget's disease of bone, and other bone diseases.

Depending on the nature of the problem, other team members may include radiologists, physical therapists, orthopedists (to treat fractures), urologists, nephrologists, endocrine surgeons (if surgery is for primary hyperparathyroidism is recommended), rheumatologists, physician assistants and nurses specially trained in calcium and bone disorders.

Occasionally, patients who have painful compression fractures of the spine may undergo verterbroplasty or kyphoplasty, both minimally invasive procedures. These procedures are performed by Medical College of Wisconsin orthopaedic surgeons, neurosurgeons and interventional radiologists.

Osteoporosis

Osteoporosis is thinning and weakening of the bone with a resultant increase in the risk of fractures occurring with minimal or no trauma. Both men and women experience bone loss during the process of aging. Although women are at greater risk for osteoporosis, men also develop this condition. A variety of hormonal and non-hormonal conditions can contribute to bone loss, and doctors will screen for these conditions during evaluation for osteoporosis. People with osteoporosis are at increased risk for fractures including spinal compression fractures, hip fractures, and a variety of other fractures. Hip fractures are the most serious because they are associated with an increased risk of death and loss of independence. Therefore, it is important to prevent these fractures when possible.

Hormones and Bone

Certain hormones are very important in maintaining calcium balance in your body as well as bone health. Bone is an active tissue and hormones are involved in the balance of bone formation and bone resorption (dissolving of bone tissue).

Many glands and hormones from the endocrine system are important in this role:

Sex hormones help retain calcium in bones to maintain bone strength. Estrogen is most important in women, and testosterone is most important in men; however both genders have both estrogen and testosterone. When estrogen levels decline in women after menopause, they lose bone density and bone strength.

The parathyroid glands (a group of four small glands located behind the thyroid) produce parathyroid hormone that regulates the calcium level in the blood. This hormone when chronically produced in excess (hyperparathyroidism) will take calcium out of bone and bring it into the blood. Interestingly, when this hormone is given by daily injection that lasts only a few hours each day, it has the opposite effect on bone and builds bone.

Vitamin D is a hormone which aids in absorption of calcium helping to form and maintain strong bones.

Thyroid hormone is made by the thyroid gland in the neck. When produced in excess (hyperthyroidism), this hormone increases removal of calcium from bones which can contribute to thinning of the bones.

The adrenal hormone cortisol, if overproduced (a condition called Cushing’s syndrome) inhibits the cells that form bone and can cause loss of bone density and bone strength.

People at risk for osteoporosis and/or fractures include:

Postmenopausal women
Women with an early menopause
People with a thin physique
Smokers
People who drink too much alcohol
People with the family history of osteoporosis or hip fracture
Organ transplant recipients
People with intestinal disease or stomach surgery
People who have had bariatric (weight loss) surgery
People on certain medications for breast cancer
People on certain medications for prostate cancer
Patients on corticosteroids (e.g. prednisone)
Patients on chronic opiates (pain killers)
Chronic use of some seizure medications
Some patients with diabetes and certain diabetes medications
Patients on proton pump inhibitors for excess stomach acid for long periods of time.

Diagnosing and evaluating osteoporosis

People with osteoporosis don’t experience symptoms until they have a fracture and they may not know they have the disease until they break a bone or they have a bone density test, typically done by dual energy X-ray absorptiometry (DXA).

Dual energy X-ray absorptiometry (DXA) is the technique most commonly used for measuring bone mineral density. Two X-ray beams with different energy levels are use to estimate the patient’s bone density. The radiation exposure is extremely low.

Verterbral fracture assessment (VFA) is done for selected patients along with the DXA test. This consists of evaluating DXA images of the spine to identify compression fractures of the vertebrae. When combined with the bone mineral density test, VFA helps determine the person's risk of future fracture.

DXA testing is recommended for the following people:

Women over age 65
Postmenopausal women under age 65 with additional risk factors for osteoporosis
Patients with fragility fractures (fractures occurring without much trauma)
Patients with diseases associated with osteoporosis or on medications associated with osteoporosis
Men over age 70
Patients on osteoporosis treatment (to monitor response)

In addition to DXA, patients typically undergo a laboratory evaluation (blood and urine) to check for problems that may cause bone loss. About one-third of postmenopausal women with osteoporosis have an underlying problem contributing to bone loss, such as vitamin D deficiency or an intestinal disorder that affects the absorption of nutrients.

Treatment of Osteoporosis

Treatment for osteoporosis is designed to prevent further bone loss and/or increase bone density and decrease fracture risk. Treatment is based on the unique needs of each patient and may include”

Taking an appropriate amount of calcium and vitamin D
Taking prescription medications to prevent bones from getting thinner and/or to increase bone density
Physical therapy for strengthen some of the back muscles and to help prevent falls
Weight-bearing exercise
Education
Lifestyle changes (e.g. smoking cessation and decreased alcohol use).

Occasionally, when patients have persistent pain after a verterbral compression fracture, verterbroplasty or kyphoplasty may be done. These are both minimally invasive procedures. In verterbroplasty, a physician uses image guidance to inject a special “cement’ mixture through a needle into the fractured verterbral body. In kyphoplasty, a balloon is first inserted through the needle into the fractured verterbral body in an attempt to restore the height of the verterbral body. The balloon is then removed and cement is injected into the space created by the balloon.

During treatment of osteoporosis, patients’ response to therapy is monitored both clinically and by bone density testing.

Hypercalcemia

Hypercalcemia (high blood calcium) is a disorder that most commonly results from primary hyperparathyroidism. A variety of other conditions can cause elevated blood calcium. Laboratory evaluation (blood and urine) by the endocrinologist will help determine the cause of elevated blood calcium.

Hypocalcemia

Hypocalcemia (low blood calcium) is a disorder with inadequate calcium in the blood. A variety of conditions such as vitamin D deficiency, intestinal disease, hypoparathyroidism (under activity of the parathyroid glands) can cause low blood calcium. Laboratory evaluation (blood and urine) by the endocrinologist will help determine the cause of low blood calcium.

Primary Hyperparathyroidism

Primary hyperparathyroidism is a hormonal problem that occurs when one or more of the parathyroid glands produce too much parathyroid hormone. The blood calcium becomes higher than normal, bones may lose calcium and kidney stones may form. If diagnosed by the endocrinologist after clinical and laboratory evaluation, surgery by an experienced parathyroid surgeon may be recommended. Medical College of Wisconsin endocrine surgeons are very experienced in minimally invasive parathyroid surgery.

Primary Hyperparathyroidism associated with Multiple Endocrine Neoplasia (MEN)

Primary hyperparathyroidism associated with multiple endocrine neoplasia (MEN), is a condition in which primary hyperparathyroidism is associated with tumors in other endocrine organs such as the pituitary and pancreas. MEN is a familial condition which involves genetic and hormonal abnormalities.

Secondary Hyperparathyroidism

Secondary hyperparathyroidism is a problem in which the parathyroid hormone is elevated in response to kidney failure or to inadequate calcium or vitamin D (e.g., caused by vitamin D deficiency, intestinal or stomach surgery, or intestinal disease). In the absence of kidney failure, secondary hyperparathyroidismism is often caused by vitamin D deficiency or stomach or intestinal disorders and is treated with calcium and vitamin D. Is this situation, surgery is not performed.

Hypoparathyroidism

Hypoparathyroidism is a condition in which the parathyroid glands have been removed surgically or do not function for other reasons. This causes low blood calcium and requires treatment with calcium and vitamin D (usually a special form of vitamin D called calcitriol).

Paget's Disease of Bone

Paget's disease of bone is a common chronic disease of bone in which one or more of the bones may be enlarged and deformed. People with this disease may have bone pain, fractures, arthritis, hearing loss, bone deformities and a variety of other symptoms. The disease is typically identified by X-rays, bone scans and blood tests. There is no cure but excellent drugs are available to treat this condition. Patients are also treated with adequate calcium and vitamin D. Occasionally patients may need bone surgery or joint replacement. This should only be done after the Paget’s disease is well controlled with medication. Medical College of Wisconsin endocrinologists are very experienced in treating Paget’s disease of bone.

Vitamin D Disorders

Vitamin D deficiency and insufficiency are associated with calcium and bone problems. Recent studies suggest a low vitamin D state is also associated with other health conditions such as heart disease and cancer. Low (inadequate levels) of vitamin D is very common in the United States.

Osteomalacia

Osteomalacia is softening of the bones caused by a variety of conditions, but most often vitamin D deficiency.

Rickets

Rickets is softening and weakening of the bones in children. This can be caused by vitamin D and calcium deficiency as well as variety of metabolic bone disorders.

Rare Bone Diseases

Fibrous dysplasia bone
McCune-Albright syndrome
Osteopetrosis
Osteogenesis imperfecta
Hypophosphatasia
Disorders of phosphate metabolism
Disorders of abnormally high bone density/osteosclerosis

Kidney Stones

The endocrinologist may advise metabolic evaluation (blood and urine tests) to help determine the cause of kidney stones and then prescribe medical and dietary treatment.

Last Review Date: Aug. 24, 2009