Supplemental Reading

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Eastell R. Treatment of postmenopausal osteoporosis. N Engl J Med 1998;338:736-746.

Fleich H. Bisphosphonates: mechanisms of action. Endocrinol Rev 1998;19:80-100.

Neer RM et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in post-menopausal women with osteoporosis. N Engl J Med 2001;344:1434-1441.

Nelson HD et al. Postmenopausal hormone replacement therapy: Scientific review. JAMA 2002;288:872-881.

Plotkin H et al. Dissociation of bone formation from resorption during two-week treatment with PTHrP (1-36) in humans: Potential anabolic therapy for osteoporosis. J Clin Endocrinol Metab 1998;83:2786-2791.

^ Case Study Hypercalcemia

Alan Aldrich is a 67-year-old white man who goes to the emergency department with lethargy, increased thirst, and increased urination for 3 days. His family states that he has been somewhat confused for the past day and is not eating or drinking as much as he should. He has a history of chronic bronchitis, a 60-pack year history of smoking, and has lost 12 lb over the past month. Physical examination reveals an arousable thin elderly white man in no acute distress. Blood pressure is 110/60; pulse is 88; respiration rate is 22; temperature is 100.3°F (37.9°C). Chest radiography reveals chronic obstructive pulmonary disease with a questionable subpleural mass on the right. His initial blood chemistry revealed serum Ca++, 13.8 mg/dL; alkaline phosphatase, 489; and elevated liver functions. What is the likely cause of his condition, and how would you treat it?

Answer: The cause of hypercalcemia most likely is malignancy. However, he may have longstanding hyperparathyroidism or milk alkali syndrome from the ingestion of large amounts of calcium carbonate to treat indigestion. He should be examined for each of these causes, but in the interim, this is a medical emergency and you have to treat empirically. The proper initial treatment is rehydration with 0.9% normal saline, use of a loop diuretic such as furosemide, and treatment with one of the intravenous preparations of a bisphosphonate, alen-dronate or zolindronic acid. Serum Ca++ is usually restored within 24 to 48 hours with this regimen. Retreatment with a bisphosphonate is often required if the patient has widespread bone metastasis. Once his serum Ca++ level is normalized, the diagnostic workup can be completed to determine the cause of the hypercalcemia.

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Natural Cures For Menopause

Natural Cures For Menopause

Are Menopause Symptoms Playing Havoc With Your Health and Relationships? Are you tired of the mood swings, dryness, hair loss and wrinkles that come with the change of life? Do you want to do something about it but are wary of taking the estrogen or antidepressants usually prescribed for menopause symptoms?

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