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Cracking the Case: The Relationship Between Bones and Hormones
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Cracking the Case: The Relationship Between Bones and HormonesPart I – Shino Yang
1. Based on Shino’s lab results, there are four areas that are abnormal. The first is her body mass index
(BMI). Her results of 17.2 places her in the underweight range. The second abnormal measurement is
her vitamin D level. It’s currently 2.5 (ng/ml) lower than what would put her within normal range.
Shino’s 24-hr urine calcium is 82 (mg/day) higher than the normal range. The last abnormal reading for
her was the bone density scan T-code. Negative one or above is within normal range and her test came
back with a level of -3.5.
2. After researching her lab results, I would diagnose Shino with Osteoporosis. The information/data that
leads me to this conclusion is her, race, her BMI, her vitamin D levels, and especially her bone density
scan. The fact that she avoids dairy products and that her mother had two broken hips are also symptoms
of osteoporosis. The main thing that’s causing her diagnosis is her bone density scan results. According
to my research, a person with a T-score of -2.5 or below has osteoporosis.
Part II – Shino’s Treatment
1. Estrogen plays a large role in bone remodeling because it bolsters the activity of osteoblasts.
Osteoblasts are the cells that produce bone. When estrogen levels drop during menopause, the osteoblasts
can’t effectively produce bone. Shino went through menopause already, so her estrogen levels dropped.
Osteoprotegerin (OPG), RANKL (osteoprotegerin ligand) and RANK are required in bone remodeling.
Estrogen does increase OPG production. Estrogen is also critical in that it regulates bone remodeling by
modulating the expression of RANKL. In layman’s terms, estrogen is needed for bone remodeling on a
cellular structure.
2. Having been asked to describe her diagnosis and risk factors, I would explain to Shino that based on
her lab results, she has been diagnosed with osteoporosis. I would then explain to her which specific
results led to the diagnosis. I would also explain to her the risk factors beginning with the ones that are
out of her control. This would include explaining to her that women are much more likely to develop
osteoporosis than men and how the older we get, the greater our risk is. Unfortunately, I would have to
tell her that she is at greatest risk of osteoporosis because she is of Asian descent. I would also explain to
her that since her mother suffered from two broken hips, that she was susceptible to osteoporosis due to
genetics. And since she has already gone through menopause seven years prior, I would still inform her
that the reduction of estrogen levels in women at menopause is one of the strongest risk factors for
developing osteoporosis. The last of the risk factor that she had no control over would be her size, so I
would tell her that men and women who have small body frames tend to have a higher risk because they
may have less bone mass to draw from as they age.
After this I would tell her of the risk factors she did have and still can have control over. This would
include her diet and lifestyle choices. The fact that she avoids dairy products had heightened her risk due
to a lack of calcium. If she has been avoiding calcium rich foods for a while, then that could have played
a role in her development of osteoporosis. Her not being as active and smoking also contributes to weak
bones and increased her risk.
3. Prolia is a biannual injection that treats osteoporosis in patients at high risk of fracture. Denosumab is
its active ingredient and is the antibody that slows down the weakening of bones. Denosumab targets the
protein (RANK Ligand) in the body that signals the cells (osteoclasts) that break down bone, preventing
these cells from forming and being activated.
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