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Bone Remodeling - anatomy 1

anatomy 1
Course

Abnormal psychology (PSY 2020)

9 Documents
Students shared 9 documents in this course
University

Chipola College

Academic year: 2022/2023
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Chipola College

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You are starting your second week of a five-week rotation with a local medical doctor. You have found

your experience exciting thus far and you’re eager to see what this week will hold. As part of your

rotation, you get to accompany the physician, Dr. Lee, on rounds and diagnoses. There are two patients

scheduled for this morning and you both head off to see the first patient.

Part I – Shino Yang

In Exam Room 1 you find Shino Yang, a 58-year-old Chinese female. Shino is here for a follow-up appointment. She broke her wrist a few months ago and is here to check on the progress and to undergo

some additional tests. Shino is a relatively healthy woman who likes to swim but admits that she hasn’t been exercising like she used to. She eats lots of vegetables and seafood, avoids most dairy products,

seldom drinks, and she smokes (she’s been trying to quit for

years). She went through menopause at the age of 51. Today, she is feeling pretty good but has some lower back pain,

and is concerned about her wrist because when her mother got older, she suffered from two broken hips. Lab Results

Measure Result Normal Range BMI (5 ́0 ̋, 88 lbs.) 17 18–24. Serum thyroxine (T 4 ) (ug/dl) 9 4– Thyrotropin (TSH) (μIU/mL) 3 0– Serum triiodothyronine (T 3 ) 120 80–

b

Breanna N

Department of BiologicalHarris

SciencesTexas Tech University,

Lubbock, TX

Cracking the Case:

The Relationship Between Bones and Hormones

NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE

(ng/dl) Blood pressure 100/66 90–120/60– Hematocrit (%) 37 36– Hemoglobin (g/100 ml blood) 11 11– Glucose (mg/dl) 86 70– Blood sodium (mmol/L) 139 135– Blood potassium (mmol/L) 3 3–5. Blood calcium (mg/dl) 8 8–10. Vitamin D (ng/ml) 27 30– 24-hr urine calcium (mg/day) 382 100– Bone density scan T-score −3 −1 or above Questions

  1. Based on the lab results, are any of Shino’s values abnormal? Yes, Shino’s bone density scan

shows that her score was -3, the normal range is -1 or above. Also, her vitamin D levels are lower

than the normal range.

  1. What is your diagnosis of Shino? What information/data leads you to this conclusion? What do you think is causing Shino’s diagnosis? (Confirm this with your instructor before moving on.) I

think Shino has osteoporosis, my reasoning for this diagnosis is the fact that her bone levels were low, and osteoporosis is the reduction of bone mass

Part II – Shino’s Treatment

  1. What role does estrogen play in bone remodeling? (Be specific; discuss RANK, RANKL and OPG.)

Estrogen plays a vital role in regulating the mass and strength of bone by controlling the bone-forming

osteoblast and bone-resorbing osteoclast. RANKL, RANK, and OPG system is used for bone resorption and helps us to understand the regulation of bone modeling and remodeling.

Part III – Eleanor Davis

You enter Exam Room 2 and meet Eleanor Davis, a 62-year-old Caucasian woman with rheumatoid

arthritis (RA). RA is an autoimmune disorder affecting the joint lining, which causes painful

inflammation, typically in the joints of the hands and feet. Eleanor’s physician has been treating her RA with 10mg daily of prednisone, a synthetic glucocorticoid, for the past two years. Glucocorticoids

repress the immune system and are thus good options for patients with autoimmune disorders. The patient has come in today for a routine visit and Dr. Lee wants to run some blood tests and a bone

density scan to make sure Eleanor is still responding to her treatment and to look for any potential

problems. Eleanor reports that she feels pretty good but has been concerned because she seems to be shorter than she once was (she noticed because some of her dresses are hanging too low).

Lab Results

Measure Result Normal Range BMI (5 ́2 ̋, 98 lbs.) 17 18–24. Serum thyroxine (T 4 ) (ug/dl) 8 4– Thyrotropin (TSH) (μIU/mL) 5 0– Serum triiodothyronine (T 3 )

(ng/dl)

93 80–

Blood pressure 130/88 90–120/60– Hematocrit (%) 38 36– Hemoglobin (g/100 ml blood) 12 11– Glucose (mg/dl) 92 70– Blood sodium (mmol/L) 137 135– Blood potassium (mmol/L) 3 3–5. Blood calcium (mg/dl) 8 8–10. Vitamin D (ng/ml) 25 30– 24-hr urine calcium (mg/day) 350 100– Bone density scan T-score −3 −1 or above

Questions

  1. Based on the lab work, are any of Eleanor’s values abnormal? BMI is low, blood pressure is higher

than the normal range, urine calcium is very high and bone density scan -T score is above the normal range.

  1. What is your diagnosis of Eleanor? What information/data leads you to this conclusion? (Confirm

this with your instructor before moving on.) Eleanor's lab results revealed disease in calcium and

vitamin D The insufficiency of vitamin D leads to an increase in body fat and decreased height. The decrease in calcium and vitamin also makes bones soft and liable to fracture. So, I think Eleanor has

osteoporosis

Part IV – Eleanor’s Treatment

Questions

  1. What role(s) do glucocorticoids play in bone remodeling? (Be specific; discuss RANK, RANKL, and

OPG.) Glucocorticoids escalate bone resorption by activating osteoclast genesis. Glucocorticoid

arrests the osteoblast differentiation and stimulates RANKL, increases the expression of the RANK

ligand. Glucocorticoids decrease osteoprotegerin release from osteoblasts because osteoprotegerin inhibits osteoclast. Osteoprotegerin decreases RANKL-RANK binding then glucocorticoids inhibit

bone formation

  1. Eleanor asks if she should take calcium and vitamin D supplements. How would you respond? Yes,

calcium and vitamin D supplements may be prescribed by doctors while treating the patient with Fosamax. It is because Fosamax may cause decreased blood calcium levels meaning that these

supplements are more than likely a must to take.

•

Case copyright held by the National Center for Case Study Teaching in Science, University at

Buffalo, State University of New York. Originally published August 4, 2016. Please see our usage

guidelines, which outline our policy concerning the permissible reproduction of this work. Licensed

image in title block © blank stock | Fotolia, id#68709154.

References

“Osteoporosis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 21 Aug. 2021, mayoclinic/diseases-conditions/osteoporosis/symptoms- causes/syc-20351968. mayoclinic/diseases- conditions/osteoporosis/symptoms-causes/syc-

“Fosamax: 7 Things You Should Know.” Drugs, drugs/tips/fosamax-patient- tips. drugs/tips/fosamax-patient-tips

AM; Canalis E;Delany. “Mechanisms of Glucocorticoid Action in Bone.” Annals of the New York Academy of Sciences, U. National Library of Medicine, pubmed.ncbi.nlm.nih/12114261/. pubmed.ncbi.nlm.nih/12114261/#:~:text=Glucocorticoids%20cause %20profound%20effects%20on,of%20its%20decoy%20receptor%2C%20osteoprotegerin.

“Journals Physiology.” American Physiological Society, journals.physiology.org/doi/full/10.1152/ajpendo.00219?cookieSet=1. journals.physiology/doi/full/10.1152/ajpendo.00219.2016?cookieSet=

Streicher, Carmen, et al. “Estrogen Regulates Bone Turnover by Targeting RANKL Expression in Bone Lining Cells.” Nature News, Nature Publishing Group, 25 July 2017, nature/articles/s41598-017-06614-0#::text=Estrogen%20is %20critical%20for%20skeletal,for%20bone%20resorption%20by%20osteoclasts. nature/articles/s41598-017-06614-0#::text=Estrogen%20is%20critical %20for%20skeletal,for%20bone%20resorption%20by%20osteoclasts.

Nagy, Vanja, and Josef M. Penninger. “The Rankl-Rank Story.” Gerontology, Karger Publishers, 14 Feb. 2015, karger/Article/Fulltext/371845. karger/Article/Fulltext/

Cheng, Chu-Han, et al. “Osteoporosis Due to Hormone Imbalance: An Overview of the Effects of Estrogen Deficiency and Glucocorticoid Overuse on Bone Turnover.” MDPI, Multidisciplinary Digital Publishing Institute, 25 Jan. 2022, mdpi/1422-0067/23/3/1376/htm. mdpi/1422-0067/23/3/1376/htm

“Exercising with Osteoporosis: Stay Active the Safe Way.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 5 June 2021, mayoclinic/diseases- conditions/osteoporosis/in-depth/osteoporosis/art-20044989#::text=Examples %20include%20walking%2C%20dancing%2C%20low,heart%20and%20circulatory %20system%20health. mayoclinic/diseases-conditions/osteoporosis/in-depth/osteoporosis/art- 20044989#::text=Examples%20include%20walking%2C%20dancing%2C%20low,heart %20and%20circulatory%20system%20health.

“Best Osteoporosis Exercises: Weight-Bearing, Flexibility, and More.” WebMD, WebMD, webmd/osteoporosis/guide/osteoporosis-exercise. webmd/osteoporosis/guide/osteoporosis-exercise

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Bone Remodeling - anatomy 1

Course: Abnormal psychology (PSY 2020)

9 Documents
Students shared 9 documents in this course

University: Chipola College

Was this document helpful?
You are starting your second week of a five-week rotation with a local medical doctor. You have found
your experience exciting thus far and you’re eager to see what this week will hold. As part of your
rotation, you get to accompany the physician, Dr. Lee, on rounds and diagnoses. There are two patients
scheduled for this morning and you both head off to see the first patient.
Part I – Shino Yang
In Exam Room 1 you find Shino Yang, a 58-year-old Chinese female. Shino is here for a follow-up
appointment. She broke her wrist a few months ago and is here to check on the progress and to undergo
some additional tests. Shino is a relatively healthy woman who likes to swim but admits that she hasn’t
been exercising like she used to. She eats lots of vegetables and seafood, avoids most dairy products,
seldom drinks, and she smokes (she’s been trying to quit for
years). She went through menopause at the age of 51. Today, she is feeling pretty good but has some
lower back pain,
and is concerned about her wrist because when her mother got older, she suffered from two
broken hips. Lab Results
Measure Result Normal Range
BMI (5´0˝, 88 lbs.) 17.2 18.5–24.9
Serum thyroxine (T4) (ug/dl) 9.0 4.6–12
Thyrotropin (TSH) (μIU/mL) 3.4 0.5–6
Serum triiodothyronine (T3) 120 80–180
“Cracking the Case” by Breanna N. Harris Page 1
b
y
Breanna N.
Harris
Department of Biological
Sciences
Texas Tech University,
Lubbock, TX
Cracking the Case:
The Relationship Between Bones and Hormones
NATIONAL CENTER FOR CASE STUDY TEACHING IN
SCIENCE

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