30 E.) Chronic kidney disease will eventually lead to hormone and electrolyte ab

Question

30 E.) Chronic kidney disease will eventually lead to hormone and electrolyte abnormalities. Renal osteodystrophy (ROD) can then lead to growth retardation, which could mean that MJ would be shorter than she might have been under normal circumstances. She might have to cope with chronic bone pain, and she would be in constant danger of fracturing her bones. As a consequence of a calcium ion level inadequate for complete fracture repair, the shape of MJ's bones could have severe abnormalities. This was more bad news, and MJ's parents were trying desperately trying to hide their concern from MJ. The growth hormone and parathyroid hormone levels were both elevated. The clinical data firmly indicated ROD at this point. The radiographs had shown a greenstick fracture in her distal left tibia. Fortunately for MJ, that was the only fracture reported in her films. The orthopedic resident would have MJ transferred to the nephrology service after she had a cast placed on her left leg.

MJ has a greenstick fracture of the distal tibia in her left leg. Which of the following statements is true with regard to bone healing in MJ's case?

a. MJ's low calcium levels will inhibit the osteoclasts from forming a soft callus, therefore leading to complications with bone healing. b. MJ's low calcium levels will inhibit the osteoblasts from forming a soft callus, therefore leading to complications with bone healing. c. Eventually the bone callus made of primary bone is replaced by the activity of osteoblasts as they break down, remodel, and then synthesize secondary bone. d. Bone healing may be abnormal because MJ's low calcium levels will inhibit osteoblasts from forming a hard callus.

Explanation / Answer

D is the correct choice. After fracture the primary response is formation of soft callus which is done within 2 weeks. The soft callous has to convert to a hard callous by mineralization of the bone and activation of osteoblasts. That means calcium has to be laid down to form new woven bone. This phase will be affected as calcium levels are low hence causing an abnormal bone healing response. Correction of calcium levels simultaneously should be advised to prevent this event.

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