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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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Biopsy of patient - bone trabecula; bone medulla; osteoid matrix. Absence of double tetracycline labeling
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f2-15-le-0037: Biopsy of patient - bone trabecula; bone medulla; osteoid matrix. Absence of double tetracycline labeling

Mentions: The biopsy revealed diminished trabecular volume (13.3%), increased osteoid surface (82%) and volume (43%), and confluent tetracycline labeling (Figure 2); thus, the hypothesis was confirmed. Serum 25-OH-vitamin D levels were determined to be 11 ng/ml (RR > 40 ng/ml). 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. Her bone mineral density improved by 38% in the lumbar spine (L1-L4 T-score −0.56) and 67.3% in the femur (neck T-score −1.21). 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.


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)

Biopsy of patient - bone trabecula; bone medulla; osteoid matrix. Absence of double tetracycline labeling
© Copyright Policy
Related In: Results  -  Collection

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

f2-15-le-0037: Biopsy of patient - bone trabecula; bone medulla; osteoid matrix. Absence of double tetracycline labeling
Mentions: The biopsy revealed diminished trabecular volume (13.3%), increased osteoid surface (82%) and volume (43%), and confluent tetracycline labeling (Figure 2); thus, the hypothesis was confirmed. Serum 25-OH-vitamin D levels were determined to be 11 ng/ml (RR > 40 ng/ml). 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. Her bone mineral density improved by 38% in the lumbar spine (L1-L4 T-score −0.56) and 67.3% in the femur (neck T-score −1.21). 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.

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.

Show MeSH
Related in: MedlinePlus