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Osteomalacia and vitamin D deficiency in the elderly.

Sitta Mdo C, Cassis SV, Horie NC, Moyses RM, Jorgetti V, Garcez-Leme LE - Clinics (Sao Paulo) (2009)

View Article: PubMed Central - PubMed

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The laboratory test results showed alkaline phosphatase (AP) 491 U/L (RR-ref range < 104 U/L); parathyroid hormone (PTH) 146 pg/ml (RR 7–62 pg/ml); total serum calcium 8.5 mg/dl (RR 8.6–10.2 mg/dl); ionized calcium 4.7 mg/dl (RR 4.6–5.3 mg/dl); serum phosphorus 3.6 mg/dl (RR 2.7–4.5 mg/dl); urinary calcium 42.3 mg/24h (RR 100–320 mg/24h); and urinary phosphate 397.4 mg/24 h (RR 400–1300 mg/24h)... The patient was prescribed calcitriol at 0.75 mg/day and 2 g of calcium carbonate to normalize PTH and alkaline phosphatase (AP) levels... Body pains and weakness were eventually reduced... Over a follow-up period of three years, the patient did not have any new fractures... Laboratory test levels had normalized to alkaline phosphatase (AP) 81 U/L (RR-ref range < 104 U/L); parathormone (PTH) 53 pg/ml (RR 7–62 pg/ml); total serum calcium 9.4 mg/dl (RR 8.6–10.2 mg/dl); ionized calcium 4.9 mg/dl (RR 4.6–5.3 mg/dl); serum phosphorus 4.4 mg/dl (RR 2.7–4.5 mg/dl); urinary calcium 151 mg/24 h (RR 100–320 mg/24 h) and serum 25-OH-vitamin D 42 ng/ml (RR > 40 ng/ml)... At present, the patient is using colecalciferol at 1000UI a day with good results... Vitamin D plays a role in bone mineralization and in the regulation of circulating calcium... Deficiency of this vitamin results in increased parathyroid hormone (PTH) synthesis and secretion... This secondary hyperparathyroidism increases bone turnover, resulting in increased risk of fracture... Osteomalacia develops when this process is intense and chronic and was histologically apparent in 13 to 33% of patients with osteoporotic femoral neck fractures., Vitamin D deficiency has been implicated in osteoporotic pathophysiology of the elderly and can cause muscle weakness as well as predisposition to falls and fractures... Osteomalacia may be associated with fractures due to minimal stress trauma and should be suspected when laboratory exams show increased levels of alkaline phosphatase (AP) with normal or decreased serum calcium and phosphorus, increased PTH (secondary hyperparathyroidism), and absence of lithic lesions and neoplasic bone disease... Vitamin D deficiency has been implicated in various pathological conditions including osteoporosis, muscle weakness and predisposition to falls and fractures. ,,, Epidemiological studies suggest that adequate serum concentrations of Vitamin D are related to reduced risk of autoimmune diseases, falls, and prostate, colon, breast and ovarian cancer., Vitamin D deficit may cause osteomalacia, which should be included in the differential diagnosis for fractures caused by minimal trauma.

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Bone scintigraphy on patient: multiple areas of osteogenic reaction
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f1-15-le-0037: Bone scintigraphy on patient: multiple areas of osteogenic reaction

Mentions: We report the case of a 62-year-old woman who had experienced body pains and weakness for two years. She had suffered from multiple fractures of the ribs and the left clavicle without trauma for two months before she was admitted to the hospital. Comorbidities included hypertension, diabetes mellitus, hypothyroidism, depression and neurological sequelae with left hemiparesis. The patient was using levothyroxine, omeprazole, metformin, glymepiride, milnacipran, mirtazapine and atenolol. Radiography showed fractures of nine costal arches and of the left clavicle. Bone scintigraphy revealed multiple osteogenic reaction areas, with predominance in the axial skeleton (Figure 1). Bone densitometry showed osteoporosis with a lumbar spine (L1–L4) T score of −3.1 and a femur (neck) T score of −2.8. The laboratory test results showed alkaline phosphatase (AP) 491 U/L (RR-ref range < 104 U/L); parathyroid hormone (PTH) 146 pg/ml (RR 7–62 pg/ml); total serum calcium 8.5 mg/dl (RR 8.6–10.2 mg/dl); ionized calcium 4.7 mg/dl (RR 4.6–5.3 mg/dl); serum phosphorus 3.6 mg/dl (RR 2.7–4.5 mg/dl); urinary calcium 42.3 mg/24h (RR 100–320 mg/24h); and urinary phosphate 397.4 mg/24 h (RR 400–1300 mg/24h).


Osteomalacia and vitamin D deficiency in the elderly.

Sitta Mdo C, Cassis SV, Horie NC, Moyses RM, Jorgetti V, Garcez-Leme LE - Clinics (Sao Paulo) (2009)

Bone scintigraphy on patient: multiple areas of osteogenic reaction
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2666480&req=5

f1-15-le-0037: Bone scintigraphy on patient: multiple areas of osteogenic reaction
Mentions: We report the case of a 62-year-old woman who had experienced body pains and weakness for two years. She had suffered from multiple fractures of the ribs and the left clavicle without trauma for two months before she was admitted to the hospital. Comorbidities included hypertension, diabetes mellitus, hypothyroidism, depression and neurological sequelae with left hemiparesis. The patient was using levothyroxine, omeprazole, metformin, glymepiride, milnacipran, mirtazapine and atenolol. Radiography showed fractures of nine costal arches and of the left clavicle. Bone scintigraphy revealed multiple osteogenic reaction areas, with predominance in the axial skeleton (Figure 1). Bone densitometry showed osteoporosis with a lumbar spine (L1–L4) T score of −3.1 and a femur (neck) T score of −2.8. The laboratory test results showed alkaline phosphatase (AP) 491 U/L (RR-ref range < 104 U/L); parathyroid hormone (PTH) 146 pg/ml (RR 7–62 pg/ml); total serum calcium 8.5 mg/dl (RR 8.6–10.2 mg/dl); ionized calcium 4.7 mg/dl (RR 4.6–5.3 mg/dl); serum phosphorus 3.6 mg/dl (RR 2.7–4.5 mg/dl); urinary calcium 42.3 mg/24h (RR 100–320 mg/24h); and urinary phosphate 397.4 mg/24 h (RR 400–1300 mg/24h).

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

The laboratory test results showed alkaline phosphatase (AP) 491 U/L (RR-ref range < 104 U/L); parathyroid hormone (PTH) 146 pg/ml (RR 7–62 pg/ml); total serum calcium 8.5 mg/dl (RR 8.6–10.2 mg/dl); ionized calcium 4.7 mg/dl (RR 4.6–5.3 mg/dl); serum phosphorus 3.6 mg/dl (RR 2.7–4.5 mg/dl); urinary calcium 42.3 mg/24h (RR 100–320 mg/24h); and urinary phosphate 397.4 mg/24 h (RR 400–1300 mg/24h)... The patient was prescribed calcitriol at 0.75 mg/day and 2 g of calcium carbonate to normalize PTH and alkaline phosphatase (AP) levels... Body pains and weakness were eventually reduced... Over a follow-up period of three years, the patient did not have any new fractures... Laboratory test levels had normalized to alkaline phosphatase (AP) 81 U/L (RR-ref range < 104 U/L); parathormone (PTH) 53 pg/ml (RR 7–62 pg/ml); total serum calcium 9.4 mg/dl (RR 8.6–10.2 mg/dl); ionized calcium 4.9 mg/dl (RR 4.6–5.3 mg/dl); serum phosphorus 4.4 mg/dl (RR 2.7–4.5 mg/dl); urinary calcium 151 mg/24 h (RR 100–320 mg/24 h) and serum 25-OH-vitamin D 42 ng/ml (RR > 40 ng/ml)... At present, the patient is using colecalciferol at 1000UI a day with good results... Vitamin D plays a role in bone mineralization and in the regulation of circulating calcium... Deficiency of this vitamin results in increased parathyroid hormone (PTH) synthesis and secretion... This secondary hyperparathyroidism increases bone turnover, resulting in increased risk of fracture... Osteomalacia develops when this process is intense and chronic and was histologically apparent in 13 to 33% of patients with osteoporotic femoral neck fractures., Vitamin D deficiency has been implicated in osteoporotic pathophysiology of the elderly and can cause muscle weakness as well as predisposition to falls and fractures... Osteomalacia may be associated with fractures due to minimal stress trauma and should be suspected when laboratory exams show increased levels of alkaline phosphatase (AP) with normal or decreased serum calcium and phosphorus, increased PTH (secondary hyperparathyroidism), and absence of lithic lesions and neoplasic bone disease... Vitamin D deficiency has been implicated in various pathological conditions including osteoporosis, muscle weakness and predisposition to falls and fractures. ,,, Epidemiological studies suggest that adequate serum concentrations of Vitamin D are related to reduced risk of autoimmune diseases, falls, and prostate, colon, breast and ovarian cancer., Vitamin D deficit may cause osteomalacia, which should be included in the differential diagnosis for fractures caused by minimal trauma.

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