Decreased bone metabolism

Introduction Systemic bone disease caused directly or indirectly by metabolic disorders such as calcium and phosphorus, but may also be highlighted as a bone change in a certain part of the body. Bone metabolic diseases mainly manifest as transitional disorders or abnormalities between bone formation and bone resorption. Bone formation or bone resorption can be reduced or increased, bone matrix formation can be lacked or increased, and mineralization can be lacked, insufficient or deposited. As a result, the bone can show looseness, softening, hardening or excessive calcification, and can have two or more manifestations.

Cause

Common bone metabolic diseases are rickets (osteogenesis in adults), osteoporosis (including primary causes such as postmenopausal, senile osteoporosis and secondary to multiple endocrine disorders or wasteful use) Osteoporosis). With the progress in the treatment and diagnosis of chronic kidney disease, renal osteopathy has attracted more and more attention. Renal osteopathy can be acquired (eg, renal osteodystrophy secondary to chronic glomerulonephritis or pyelonephritis). It can also be hereditary, such as renal tubular acidosis, familial hypophosphatemia (phosphorus), pseudo-vitamin D deficiency (vitamin D-dependent rickets) and Fanconi's syndrome. Local skeletal fluorosis is chronically distributed in China due to long-term reference to high fluoride water, consumption of high fluoride content of food, vegetables or air pollution. A iatrogenic bone metabolic disease such as long-term use of anticonvulsant drugs or galchoxemia caused by aluminum hydroxide. Some diseases such as osteoarthritis, osteogenesis imperfecta, and osteopetrosis have a wide range of bone changes, which are also attributed to the category of bone metabolism. Other bone metabolic diseases include endocrine changes caused by malignant tumors, heterologous endocrine syndrome and abnormal proliferation of bone fibers.

an examination

Related inspection

Determination of bone mineral density in limbs by serum osteocalcin (BGP)

Bone metabolic diseases often show bone pain, fracture, muscle weakness or deformity in clinical practice. In a few cases, there may be corneal calcification and hand and foot sputum.

Differential diagnosis

Differential diagnosis of bone metabolism reduction:

Low bone mass refers to a decrease in bone density or a decrease in mineral content in the bone. Osteoporosis and other bone diseases such as osteomalacia, osteogenesis imperfecta, Paget bone disease and bone fiber dysplasia can be expressed as low bone mass, but the internal components and structural changes of the bone are very different and need to be carefully identified. .

1 Osteoporosis: The proportion of bone minerals and organic matter is reduced, the cortical bone is thinned, the trabecular bone is slender, and the structure is disordered.

2 Osteomalacia: bone minerals are reduced, but organic matter is not reduced, or even increased, bone-like accumulation, poor mineralization.

3 osteogenesis imperfects: abnormal organic structure, resulting in a decrease in the overall density of bone minerals.

4 Paget bone disease: mainly manifested as skeletal structure disorder, bone expansion and expansion.

In addition, there are other hereditary, neoplastic or inflammatory diseases that can lead to low bone mass. It is necessary to ask a detailed history, and complete the relevant examination according to the condition to make a diagnosis.

Common causes of secondary osteoporosis include endocrine and metabolic diseases, connective tissue diseases, renal osteodystrophy caused by various chronic kidney diseases, gastrointestinal nutritional diseases (digestive tract diseases) and liver diseases, blood system diseases, nerves Muscle system disease, long-term braking or space travel, organ transplants, and some drugs, toxic effects.

The most common of these diseases are glucocorticoid-induced osteoporosis, hyperparathyroidism, chronic renal failure, Cushing's syndrome, hyperthyroidism, gastrointestinal malabsorption, organ transplantation, immobilization, and tumors. Among them, glucocorticoid-induced is the most common, and tumor-induced is the most serious.

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