Approach to the Patient with Metabolic Bone Disease

Publisher Summary Metabolic bone disease encompasses a considerable number and variety of conditions. Although these disorders are often rare, several are epidemic in various regions of the world. Some can be life threatening; others can be incidental findings. Cumulatively, the number of individuals with clinically important metabolic bone disease is significant. This chapter emphasizes a number of considerations for the approach to the patient with metabolic bone disease, particularly those with disturbances in vitamin D homeostasis. The complex interaction of the many exogenous and endogenous factors impact vitamin D homeostasis. Demonstration of concern for, and commitment to, the patient begins with a complete medical history and thorough physical examination that wins their confidence and trust. Such rapport will likely be essential for effective management of what will often prove to be a chronic disorder. Physical examination is crucial not only for diagnosis, but to uncover structural skeletal problems. Information gathered by the medical history and physical examination is the guide to the myriad of biochemical, radiological, and other technologies that can assist to establish the etiology and pathogenesis and to set the stage for subsequent treatment and follow-up. Effective therapies are available for derangements of vitamin D homeostasis, but the pharmaceuticals vary significantly in potency, duration of effect, and cost. Once the proper clinical foundation is in place, the physician is usually gratified by a patient that he/she has greatly helped.