Bone and Calcium Disorders

Questions discussed in this category

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

Would you transition from denosumab to anabolic agents in patients who are in urgent need for extensive dental work?

1 Answer available

What is your approach to managing osteoporosis in patients with end stage 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

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

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 ...

1 Answer 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

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 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

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

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

How should very low T scores (worse than -3) be interpreted in very thin patients (BMI < 18)?

1 Answer available