Approach to the Patient With Metabolic Bone Disease

"Metabolic bone disease" encompasses disorders ranging from epidemic to ultrarare. The list is growing partly because the genetic bases are being revealed using next-generation DNA technology for the many previously enigmatic syndromes and dysplasias of the skeleton. Patient ages are similarly broad-ranging. Hence, safe and effective management of these conditions can be challenging. Clinicians have an expanding array of tools for diagnosis, and the number of drugs, biologics, supplements, etc., for treatment is increasing often with greater potency. These advances must be selected, interpreted, and applied knowledgably. Clinical acumen and judgment are more important than ever. This chapter reviews considerations for physicians when a patient with metabolic bone disease is referred, including those with disordered vitamin D homeostasis. It emphasizes the value of the thorough and complete "medical history" and the significance of the subsequent physical examination before laboratory testing and patient treatment.