AGENTS AFFECTING BONE MINERAL METABOLISM

Brief History. R.D. is a 74-year-old woman with a history of generalized bone demineralization caused by osteomalacia that was primarily brought on by poor diet; her total caloric intake and dietary levels of calcium and vitamin D have been very low. The patient is also rather reclusive, spending most of her time indoors. Consequently, she lacks any signifi cant exposure to natural sunlight. To treat her osteomalacia, she was placed on a regimen of oral calcium supplements and vitamin D. How ever, she has been reluctant to take these supplements because they occasionally cause diarrhea. Recently, she sustained a fracture of the femoral neck during a fall. She was admitted to the hospital, and the fracture was stabilized by open reduction and internal fi xation. The patient was referred to physical therapy for strengthening and pre-weight-bearing activities. Problem/Infl uence of Medication. During the postoperative period, calcium and vitamin D supplements were reinstituted to facilitate bone formation. The patient soon began to experience bouts of diarrhea, apparently as a side effect of the vitamin D supplements. Consequently, the vitamin D supplements were withdrawn, and only the calcium supplement was continued. Because metabolic by-products of vitamin D accelerate the absorption of calcium from the GI tract, both agents should be administered together. This patient, however, was apparently unable to tolerate vitamin D (or its analogs), possibly because of hypersensitivity to these compounds.

1. Which physical agent might help stimulate vitamin D production in this patient?

2. How can this physical agent affect bone metabolism?

3. How can the therapist incorporate the physical agent into the comprehensive treatment for this patient?