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ENDOCRINE SYSTEM

689

Management of hypoparathyroidism may consist of any of the

foliowing8.'J .• 7:

•

Dietary modifications that promote a diet high in calcium and

low in phosphate

•

Pharmacologic intervention with the following:

PTH

Vitamin 0 supplements: dihydrotachysterol (Hytakerol),

dihydroxycholecalciferol, or ergocalciferol (Calciferol) (vitamin 0,)

Nutritional supplements: calcium gluconate, calcium glubionate, calcium lactate, or calcium chloride

Metabolic 80l/e Disorders

Osteoporosis

Osteoporosis is a multifactorial skeletal disotder that leads to

decreased bone density and organization, which ultimately reduces

bone strength." Bone strength is often measured by bone mineral

density studies, which are used in the diagnosis of osteoporosis, as

well as moniroring rools for therapeutic improvements. Osteoporosis

can be classified a primary or secondary. Primary osteoporosis can

occur in both genders at all ages, but often follows menopause in

women and occurs later in life in men. Secondary osteoporosis is a

result of medications (e.g., glucocorticoids or anticonvulsants), alcoholism, other conditions (e.g. , hypogonadism or hypoestrogenism), or diseases (e.g., hyperthyroidism)."

There is no clear etiology for osteoporosis. However, many risk

factors for women have been elucidated. These risk factors include

white or Asian racc, petite frame, inadequate dietary intake of calcium, positive family history of osteoporosis, alcohol abuse, cigarette smoking, high caffeine intake, sedentary lifestyle, reduced bone minerai coment (most predictive factor), and early menopause or oophorectomy (ovary removal).1.·7 .• ,

Signs and symptoms of osteoporosis may include the

followingl.'7:

•

Back pain (aggravated by movement or weight bearing, relieved

by rest)

•

Vertebral deformity (kyphosis and anterior wedging)

690

ACUTE CARE HANDBOOK FOR I)HVSICAI. THERAPIST'S

•

Presence of vertebral compression fractures, Calles' fracture, hip

and pelvic fractures

Management of osteoporosis may consist of any of the

foliowingJ,49.50:

•

Daily supplementation with calcium and vitamin D for all women

with low bone mineral density

•

Hormone replacement therapy with estrogen or estrogen combined with progesterone

•

Estrogen receptor modulation therapy with raloxifene hydrochloride

•

Bisphosphonate supplementation (inhibits bone resorption) with

alendronate sodium or risedronate sodium

•

Calcitonin supplementation (increases total body calcium)

•

Physical therapy for exercise prescription

•

Fracture management (if indicated, refer to Chapter 3)

•

Administration of PTH (in research stages)

Clinical Tip

•

Always consult with the physician to determine whether

there are any weight-bearing precautions in patients with

osteoporosis.

•

An abdominal corset can provide additional support for

stable vertebral compression fracture(s).

•

Also, using a rolling walker that is adjusted higher than

normal can promote a more upright posture. Both of these

techniques may also help to decrease back pain in patients

with osteoporosis.

•

Gentle exercises to improve the strength of thoracic

extensors can also a sist with posture and reduce back

pain.

•

Caution with resistive exercises and manual contacts

should be taken during therapeutic activities to avoid risk

of microtraurna or fracture to osteoporotic bones.

ENDOCRINE SYSTEM

691

Osteomalacia

Osteomalacia, or rickets in children, is a disorder characterized by

decreased bone mineralization, reduced calcium absorption from the

gut, and compensatOry hyperparathyroidism. The etiology of osteomalacia stems from any disorder that lowers serum levels of phosphate, calcium, or vitamin 0.11•47

Signs and symptOms of osteomalacia may include the following".47:

•

Bone pain and tenderness

•

Softening of cranial vault (in children)

•

Swelling of costOchondral joints (in children)

•

Predisposition to femoral neck fractures (in adults)

•

Proximal myopathy

•

Waddling gait

Medical management of osteomalacia may consist of treating the

underlying or predisposing condition or supplementation with calcium and vitamin 0.11•51

Paget's Disease

Paget's disease is a bone disease of unknown etiology that usually presents after the age of 55 years. The primary feature is thick, spongy bone that is unorganized and brittle as a result of excessive osteoclastic and subsequent osteoblastic activity. Some evidence points to an inflammarory or viral origin. Fractures and compression of the cranial

nerves (especially the eighth nerve) and spinal cord are complications

of Paget's disease.47,52

Paget's disease is generally asymptomatic; however, the following

clinical manifestations may present4 7•52:

•

Bone pain that is unrelieved by rest and persists at night

•

Bone deformity (e.g., skull enlargement, bowing of leg and

thigh)

•

Increased warmth of overlying skin of affected areas

•

Headaches or hearing loss

Management of Paget's disease consists primarily of bisphosphonate administration (oral etidronate, alendronare, tiludronare, rised-