Some patients who are taking high doses of a bisphosphonates for Paget’s disease of the bone develop an endocrine-metabolic disorder. Which of the following is the most likely disorder? (AIIMS Nov 13)
|A||Cushing’s disease (cushingoid symptoms)|
a. You should be able to deduce hyperparathyroidism as the answer by recalling that the bisphosphonates ultimately affect bone Ca2+ metabolism, and the parathyroid gland is the main regulator of serum Ca2+ levels.
b. When a bisphosphonate is given to a patient with Paget’s disease of the bone, after about a week the dramatic inhibition of bone resorption dramatically lowers serum Ca2+ levels (because an important portion of serum Ca2+ arises from bone that is being resorbed).
c. When serum Ca2+ falls considerably, parathyroid hyperfunction can develop. The easiest way to prevent this is to administer dietary calcium supplements along with the bisphosphonate.