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CHAPTER 42 Agents That Affect Bone Mineral Homeostasis 791

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C ASE STUD Y ANSWER

There are multiple reasons for this patient’s osteoporo- gonadotropin production, leading to hypogonadism. Man-
sis, including a heavy smoking history, possible alco- agement should include measurement of serum testoster-
holism, and chronic inflammatory disease treated with one, calcium, 25(OH)D, and the 24-hour urine calcium
glucocorticoids. High levels of cytokines from the chronic and creatinine levels (to verify completeness of collection),
inflammation activate osteoclasts. Glucocorticoids increase with treatment as appropriate for these secondary causes,
urinary losses of calcium, suppress bone formation, and plus initiation of bisphosphonate or denosumab therapy as
inhibit intestinal calcium absorption as well as decreasing primary treatment.