CASE STUDY 1
CASE STUDY 1
the patient was bedridden for two weeks; no exposure to sunlight and the inability to synthesize
Vitamin D can cause vitamin D deficiency which leads to bone diseases.
Tajika et al. (2004) states, the main function of Vitamin D is to preserve calcium and
phosphorus homeostasis by increasing the efficiency of intestinal calcium and phosphorus
absorption to maintain signal transduction, metabolic activities, neuromuscular function, and
promote skeletal mineralization. Vitamin D deficiency may contribute to the development of
metabolic bone diseases such as osteoporosis or osteomalacia (Tajika et al, 2004, p.527). The
patient is currently taking a multivitamin and calcium 500mg/day, but her intestinal tract is
unable to absorb dietary supplements taken by mouth or pill form. The Short Bowel Syndrome
(SBS) is a global malabsorption syndrome due to insufficient absorptive capacity and/or
disturbed gastrointestinal regulation resulting from extensive small bowel resections (Keller,
Panter, & Layer, 2004, p.978).
In order for this patient to effectively receive daily supplements, the patient would have
to receive parenteral supplementation. Enteral feeding should be encouraged unless this leads to
unmanageable fistula outputs. A home parenteral nutrition (HPN) service should be available to
the patient (Peck, Soo, Boland, Windsor, and Engledow, 2012, p.2).
2.) Which of the following statements regarding laboratory tests in metabolic bone
disease is false? Explain your answer.
a.) serum calcium is typically normal in patients with osteoporosis. True. The
population of individuals with osteoporosis is usually older with decreased bone density. A
normal bone density achieved in childhood will lead to mild osteoporosis at old age if calcium
intake is adequate throughout lifetime (Cirdeiu and Anton-Paduraru, 2013, p.116). It is
CASE STUDY 1
important for older individuals to consume the daily recommended amount of calcium to prevent
the possibility of fractures from falls and osteoporosis.
b.) alkaline phosphatase is typically elevated in osteoporosis. False. Osteoporosis is a
common disease among older individuals. Menkes (2013) states, osteoporosis is characterized
by normal serum levels of calcium, phosphate, and alkaline phosphatase (Menke, 2013, p.9).
c.) serum phosphorus is typically normal in patients with Paget disease. True. The
breakdown and buildup of bone is essential in regulating the levels of calcium and phosphorus in
the blood. In most people with Paget disease, these levels remain normal. Certain conditions can
cause the balance to be disrupted, such as inactivity or the presence of a second disorder such as
hyperparathyroidism (Seton, 2012, p.1).
d.) patients with hyperparathyroidism often develop hypercalcemia. True. Primary
hyperparathyroidism and malignancy account for around 90% of cases of hypercalcemia.
Maintenance of normal calcium levels is under tight regulation by parathyroid hormone (PTH)
and vitamin D( Crowley & Gittoes, 2013, p.287).
3.) For each of the following metabolic bone diseases listed below, give a brief
definition of the disease, and briefly discuss what laboratory values that are helpful to
diagnose the disease. In addition, complete the following chart using arrows to denote
increased, decreased, or within normal range.
Osteomalacia is a bone disorder characterized by demineralization of the bone.
Individuals who suffer from primary conditions such as malabsorption syndrome can develop
secondary osteomalacia due to abnormalities in absorbing nutrients need to maintain bone health
and growth. Goula, Vervveridis, and Drosos (2012) stated, osteomalacia arises from a disorder
in the physiological process of bone turnover where the mineralization phase of bone remodeling
CASE STUDY 1
CASE STUDY 1
Serum Calcium
Serum Phosphorus
Alkaline
Phosphatase
Osteomalacia
Paget Disease
Hyperparathyroidism
4.) What is the most likely mechanism of osteomalacia in this patient? Explain your
answer.
In reviewing the case study, the most likely mechanism of osteomalacia involving this
patient may be due to nutritional deficiencies and the inability to absorb nutrients due to Crohns
disease. Menkes (2013) stated, osteomalacia should be suspected in cases of bone pain
CASE STUDY 1
associated with malabsorption, gastric bypass surgery, celiac sprue, chronic hepatic disease, and
chronic kidney disease (Menke, 2013, p.9). Due to the cobblestone formation within the
intestinal tract, the mucosa is unable to absorb calcium or Vitamin D, which is needed to regulate
calcium and phosphorus. The lab values demonstrated in the case clearly demonstrate values
indicated in osteomalacia such as decreased calcium, decreased phosphorus, and an increased
alkaline phosphatase. The patient also demonstrates the signs and symptoms associated with
osteomalacia such as bone pain and tenderness.