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Old 03-25-2011
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Bones Which test you order for steroid induced osteoporosis?

A 34-year-old asthmatic male presents for a check-up. He has been taking low dose oral prednisone for over 10 years and although his asthma is well controlled, he is concerned about steroid-induced osteoporosis, because his grandfather, a type 1 diabetic, recently fell and broke his hip. A comprehensive metabolic profile as well as a dual energy x-ray absorptiometry test (DEXA) of the spine and hip are ordered. Which of the following additional tests would be recommended?
A. 1,25-dihydroxy vitamin D
B. C-terminal PTH
C. Intact PTH
D. Serum glucose
E. Serum protein electrophoresis
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Old 03-25-2011
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Prednisone is one of glucocorticoid hormone that will induce enzyme involved in gluconeogenesis (Phosphoenolpyruvate Carboxykinase /PEPCK). Long term use may cause hyperglycemia and predisposing patient to get DM.

The answer is : D
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Quote:
Originally Posted by harlesmd View Post
Prednisone is one of glucocorticoid hormone that will induce enzyme involved in gluconeogenesis (Phosphoenolpyruvate Carboxykinase /PEPCK). Long term use may cause hyperglycemia and predisposing patient to get DM.

The answer is : D
Hmm...this is not answering the questions huh ??? this is a challenging question...
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Old 03-25-2011
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maybe C. glucocorticoids increase PTH levels and block the intestinal effects of Vit D.
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Old 03-25-2011
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Quote:
Originally Posted by harlesmd View Post
Hmm...this is not answering the questions huh ??? this is a challenging question...
I would go for D as well...
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Old 03-25-2011
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Hmm... confusing... I guess dual energy x-ray absorptiometry test is already bin ordered which will confirm osteoporosis and offending agent being very obvious... I won't like to go for Intact PTH which I think includes C - PTH... I would like to go for serum glucose... Atleast we can cover one more side effect with minimum number of investigations... My answer will be D
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The correct answer is D. This patient has a family history of diabetes. Steroid-induced diabetes mellitus is a frequent consequence of long-term corticosteroid therapy. It can be triggered by prednisone with or without a family history, but a predisposition may increase the risk. Symptoms such as polyuria and weight loss may be masked by the disease for which the patient is taking steroids.Measurement of 1,25-dihydroxy vitamin D (choice A), the active vitamin D metabolite, would not be recommended. Corticosteroids can alter calcium balance mainly to due vitamin D deficiency secondary to impaired intestinal absorption of calcium, but 25-hydroxy vitamin D is a better marker for assessing nutrition.PTH, an 84 amino acid polypeptide, can be cleaved into an active N-terminal fragment and an inactive C-terminal fragment. Measurement of C-terminal PTH (choice B) is not recommended. Although PTH is a regulator of calcium homeostasis, these fragment molecule measurements have not been found to correlate well with true PTH activity on bone.Although PTH is a calcium regulator in the body, it is not considered a major contributor to corticosteroid-induced bone loss, so measurement of intact parathyroid hormone (choice C) is not the best choice. It is only significant if a person has underlying malabsorption such as inflammatory bowel disease.Serum protein electrophoresis (choice E) is used mainly for the diagnosis of multiple myeloma in patients with pathologic fractures or a high clinical suspicion of myeloma.
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