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Bone and Calcium Disorders   

Questions discussed in this category

What is your experience with using anabolic therapy for treatment of osteoporosis in patients with EtOH cirrhosis and is one agent preferred over another (PTH analogue vs Evenity)?
Lack of large scale efficacy or safety data for PTh analogue or Evenity in this patient population.
2 Answers available
Is it safe to continue administering Prolia per schedule for osteoporosis treatment shortly after a patient has undergone extensive spinal surgery?
2 Answers available
Would you continue Forteo treatment past the recommended 2 years if T scores remain low and procollagen (P1NP) is elevated and if so, how would you monitor response?
1 Answer available
Do you recommend adjusting the duration of a drug holiday based on the specific bisphosphonate used when treating osteoporosis?
1 Answer available
Would elevated bone mineral density/T-score be enough to make a diagnosis of osteopetrosis?
1 Answer available
What is the likelihood of recovery of parathyroid gland function for patients who underwent total thyroidectomy, found to have embedded parathyroid glands intra-operatively and then subsequently had them re-implanted into neck muscle?
1 Answer available
Would you order a repeat DEXA scan 1 year later for a kidney transplant patient who had an initial DEXA scan within the first 6 months post-transplant showing osteopenia but no history of fractures, and who has been stable on glucocorticoid-free immunosuppressive therapy?
2 Answers available
Would you recommend waiting for a low Vitamin D level to correct to goal prior to giving a scheduled Prolia injection when transitioning a patient from Zolendronic acid to Prolia therapy for worsening osteoporosis?
2 Answers available
How do you determine osteoporosis treatment response when patients have discrepant DEXA scan results during monitoring (eg improved BMD of the hip and spine but worsening BMD of the femoral neck)?
1 Answer available
Do oral contraceptives lower bone mineral density in women with hypothalamic amenorrhea by lowering IGF-1?
1 Answer available
What treatment options would you consider for a young patient with limited mobility, low bone mass and multiple vertebral compression fractures who is on dialysis for advanced kidney disease?
1 Answer available
How do you reduce the risk of contralateral fracture in a patient with atypical femur fracture from prolonged bisphosphonate use?
Do anabolic agents have a role?
1 Answer available
How frequently do you monitor for hypocalcemia in patients on romosozumab?
1 Answer available
What is the utility of near-infrared autofluorescence (NIRAF) imaging during parathyroid surgery?
2 Answers available
When discontinuing Denosumab after more than 2-3 years of therapy, when do you recommend giving the first dose of zoledronic acid?
2 Answers available
How do you manage osteoporosis treatment following parathyroidectomy for primary hyperparathyroidism?
1 Answer available
How should patients time the ingestion of their alendronate and levothyroxine given issues with food/drug interactions?
With the time intervals recommended after taking each medicine, I am wondering how patients should be counseled.
1 Answer available
Would you stop denosumab in a patient with chronic kidney disease if they develop asymptomatic hypocalcemia after the injection?
4 Answers available
Would you consider PTH analogue in a patient with mildly elevated PTH?
2 Answers available
Does vitamin D supplementation in primary hyperparathyroidism increase the risk of kidney stones?
Is this seen more with high dose vitamin D supplementation?
1 Answer available
Have you been able to safely use other bisphosphonates in patients who developed an allergic reaction (angioedema) to fosamax?
1 Answer available
When do you recommend using trabecular bone score (TBS) for managing osteoporosis?
1 Answer available
Are there any concerns with live vaccine innoculation and patients who are on denosumab?
1 Answer available
Which fracture sites outside of the classical spine and hip are considered to be osteoporotic fractures even in the absence of a bone density diagnosis?
2 Answers available
How do you approach a patient with elevated bone specific ALP (>2X the normal limit), but no other evidence of Paget's disease?
Normal Vitamin D, bone scan showed osteoarthritis
1 Answer available
Do you recommend a particular antiresorptive/anabolic agent for patients who are at high risk for fractures but have high risk of osteonecrosis of the jaw?
3 Answers available
Is there any contraindication for use of Invisalign teeth aligners in patients undergoing treatment for osteoporosis?
Do treatments for osteoporosis have a large enough effect on tooth movement to make Invisalign less effective?
1 Answer available
Would you transition from denosumab to anabolic agents in patients who are in urgent need for extensive dental work?
2 Answers available
Do you recommend parathyroid imaging testing for patients with recurrent nephrolithiasis who are incidentally found to have an elevated PTH but who do not have hypercalciuria, hypercalcemia, hypovitaminosis D, or chronic kidney disease?
2 Answers available
Would you add cholecalciferol or ergocalciferol to calcitriol therapy in patients with post operative hypoparathyroidism who have low 25 OH vitamin D levels?
Can 25 OH vitamin D be converted to activated vitamin D outside of PTH mediated mechanisms in some organs? 
2 Answers available
For a patient with idiopathic hypercalciuria and a history of calcium kidney stones who has not normalized 24-hr urine calcium level on thiazide diuretic, is there evidence for targeting a certain urine calcium level for decreased future risk of nephrolithiasis and osteoporosis?
2 Answers available
What is your approach to progressive calvarial hyperostosis found in an elderly adult not caused by Pagets, acromegaly or hypercalcemia?
No evidence for acromegaly or Pagets. 
1 Answer available
Given the risk of hypocalcemia in dialysis dependent patients treated with denosumab, what is the best method of treatment for osteoporosis for these patients, and should we be transitioning to a different agent?
2 Answers available
In patients presenting with classical findings of primary hyperparathyroidism (i.e mild hypercalcemia, high 24hr urine calcium, elevated 1,25 Vit D but normal PTH), can spontaneous normalization of calcium be explained by episodic hypersecretion of PTH?
1 Answer available
Do you routinely use anti-resorptive medications in patients who have osteoporosis and longstanding hypoparathyroidism?
1 Answer available
How reliable is the FRAX score for assessing risk of osteoporotic fractures?
1 Answer available
Is there any role for 25-OH Vitamin D testing in patients older than 75 years old in the general population?
Demay, et al., PMID 38828931
2 Answers available
Does biotin interfere with the measurement of other metabolites of the Vitamin D pathway outside of the 25-hydroxy Vitamin D assay?
1 Answer available
How would you approach a finding of osteoporosis (Z score -4.5) in a recently postpartum patient who had DEXA sent for long-term low-dose glucocorticoid use?
The patient is actively breastfeeding.
1 Answer available
Is there any evidence regarding bone density gains/fracture reduction in the setting of treatment with romosozumab after a two year course of teriparatide?
Many patients are interested in romosozumab for "maximizing bone gain" and preventing future fractures. Some have had anabolic therapy with teriparati...
1 Answer available
What is the utility of an oral calcium loading test to differentiate FHH from secondary hyperparathyroidism due to low calcium intake?
The patient has very low urinary calcium despite calcium supplements, vitamin D used to be low now normal. Continues to have elevated PTH with normal ...
2 Answers available
What range of musculoskeletal complaints have you seen with romosozumab use?
1 Answer available
Would you consider exploratory surgery in a young patient with normocalcemic hyperparathyroidism that meets one or more criteria for parathyroidectomy but has no localized pathology on advanced neck imaging?
1 Answer available
What is your approach to managing osteoporosis in patients with end stage kidney disease?
1 Answer available
Would you use romosozumab in a patient with a cardiovascular event more than 2 years prior?
4 Answers available
Would you refer a patient for parathyroidectomy if they have normal calcium levels, mild hyperparathyroidism, and evidence of osteopenia?
2 Answers available
Do you recommend osteoporosis medication in postmenopausal females on anastrozole with very low Vitamin D (4.5)?
After replacing Vitamin D, what will be your first treatment of choice? Labs including ALP and calcium levels are normal. T scores are -3 or above. Th...
1 Answer available
Following abaloparatide use for osteoporosis treatment, how long do you consolidate with bisphosphonates before considering a drug holiday?
1 Answer available
After completing 12 months romosozumab, what is the next best treatment option for patients with severe osteoporosis, high risk for fracture, and normal kidney function?
1 Answer available
Should patients who develop primary hyperparathyroidism after 5 years of Prolia treatment for osteoporosis be referred for parathyroidectomy?
If so, when? Does surgery need to be timed with last dose of Prolia injection?
1 Answer available
How do you distinguish between primary and tertiary hyperparathyroidism in a patient with ESRD?
1 Answer available
Would you consider anabolic osteoporosis therapy in a young adult male with multiple non-traumatic vertebral compression fractures and low bone density for age (Z-score -2.6)?
A male patient in his 30s with two lumbar compression fractures (non-traumatic) and a Z-score of -2.6 in the spine, Z-score -0.5 in hips. History of 3...
1 Answer available
How long do you wait before reassessing a 24 hour urine calcium level in patients with recurrent nephrolithiasis, hypercalciuria, and osteoporosis who are initiated on bisphosphonate therapy?
3 Answers available
Do you treat hypercalciuria in post menopausal osteoporosis with normal serum calcium and PTH?
2 Answers available
Aside from lifestyle measures such as calcium intake, vitamin D repletion, and weight-bearing exercises and ruling out all secondary causes, what is the preferred approach to managing osteoporosis in young women with Z score of less than -2.5 and planning to get pregnant soon?
2 Answers available
In patients with secondary osteoporosis due to primary hyperparathyroidism, should parathyroidectomy be recommended in the setting of recent prior bisphosphonate use?
1 Answer available
Have the results of the ancillary study of the VITAL trial, demonstrating that Vitamin D3 supplementation did not reduce the incident rate of fractures in generally healthy midlife and older adults, changed how you prescribe Vitamin D?
PMID 35939577
2 Answers available
How do you manage osteoporosis in patients with anorexia nervosa (who often are young women < 40)?
2 Answers available
Is it possible for certain individuals with osteoporosis to be a denosumab "non-responder"?
I’ve seen several such patients who have no secondary causes for bone loss, on adequate calcium/vitamin D, and compliant with denosumab who do n...
1 Answer available
Can joint replacement surgery be performed in someone with active Paget’s disease elsewhere?
1 Answer available
Despite low T scores (-2.5 or worse), what is the actual fracture risk in relatively younger patients (early 50s to mid 60s) with low BMD?
Should this patient population be treated differently? At our institution, we have started using EPIC to screen many patients for osteoporosis and ou...
1 Answer available
Would you start osteoporosis treatment in patients with low FRAX scores but have T scores lower than -2.5?
1 Answer available
How should very low T scores (worse than -3) be interpreted in very thin patients (BMI < 18)?
1 Answer available


Papers discussed in this category

The lancet. Diabetes & endocrinology, 2019 Aug 22
Combination denosumab and high dose teriparatide for postmenopausal osteoporosis (DATA-HD): a randomised, controlled phase 4 trial.
JBMR plus, 2021 Aug 30
New Insights Into Osteoclast Biology.
World journal of surgery, 2004 Apr 19
Recovery of bone mineral density in 126 patients after surgery for primary hyperparathyroidism.
Arteriosclerosis, thrombosis, and vascular biology, 2019-07
Cardiovascular Outcomes of Romosozumab and Protective Role of Alendronate.
Clinical journal of the American Society of Nephrology : CJASN, 2017-08-07
Low Bone Density and Bisphosphonate Use and the Risk of Kidney Stones.
Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 2018-10-05
CALCIUM CREATININE CLEARANCE RATIO IS NOT HELPFUL IN DIFFERENTIATING PRIMARY HYPERPARATHYROIDISM FROM FAMILIAL HERPERCALCEMIC HYPOCALCIURIA: A STUDY OF 1000 PATIENTS.
Joint bone spine, 2021 May 19
Effects of prior osteoporosis treatment on 12-month treatment response of romosozumab in patients with postmenopausal osteoporosis.
Genes, 2022 Oct 17
Hereditary Metabolic Bone Diseases: A Review of Pathogenesis, Diagnosis and Management.
JAMA, 2007-01-24
Risk of subsequent fracture after low-trauma fracture in men and women.
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2017-07
Osteoporosis in Crisis: It's Time to Focus on Fracture.
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2019 Dec 01
Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition.
JAMA network open, 2022 Oct 03
Association of Multimorbidity and Excess Mortality After Fractures Among Danish Adults.
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2022 Oct 17
The Economic Burden of Severe Osteoporotic Fractures in the French Healthcare Database: The FRACTOS Study.
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2020 Mar 16
Fracture risk following high-trauma versus low-trauma fracture: a registry-based cohort study.
Current osteoporosis reports, 2021 Feb 01
Approaches to Fracture Risk Assessment and Prevention.
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2023 Jul 01
Update on the clinical use of trabecular bone score (TBS) in the management of osteoporosis: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), and the International Osteoporosis Foundation (IOF) under the auspices of WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging.
The New England journal of medicine, 1980-02-21
The importance of circulating 1,25-dihydroxyvitamin D in the pathogenesis of hypercalciuria and renal-stone formation in primary hyperparathyroidism.
The New England journal of medicine, 2018 Sep 13
Primary Hyperparathyroidism.
Frontiers in endocrinology, 2023 Dec 04
Near-infrared fluorescent imaging for parathyroid identification and/or preservation in surgery for primary hyperparathyroidism.

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