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Osteomalacia and vitamin D deficiency in a psychiatric rehabilitation unit: case report and survey.

Cardinal RN, Gregory CA - BMC Res Notes (2009)

Bottom Line: Vitamin D deficiency is common and predisposes to many serious diseases, yet often goes unrecognized.We describe a case of severe vitamin D deficiency with osteomalacia in a patient resident in a psychiatric hospital for more than 35 years, and discuss causes and complications.We assayed the serum 25-hydroxyvitamin D levels of all patients under our care on one old-age psychiatry rehabilitation unit.

View Article: PubMed Central - HTML - PubMed

Affiliation: Behavioural and Clinical Neurosciences Institute and Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK. rudolf.cardinal@pobox.com

ABSTRACT

Background: Vitamin D deficiency is common and predisposes to many serious diseases, yet often goes unrecognized.

Findings: We describe a case of severe vitamin D deficiency with osteomalacia in a patient resident in a psychiatric hospital for more than 35 years, and discuss causes and complications. We assayed the serum 25-hydroxyvitamin D levels of all patients under our care on one old-age psychiatry rehabilitation unit. Ten of twelve (83%) of patients had vitamin D deficiency, and 92% had suboptimal vitamin D levels. Vitamin D status was strongly predicted by dietary supplementation. Of those not on vitamin D supplements, 100% had vitamin D deficiency, with vitamin D levels significantly below those of historical controls. Age, sex, and duration of admission did not predict vitamin D status in this group.

Conclusion: We advocate vitamin D screening in all patients admitted to psychogeriatric units, and discuss treatment options given the current problems affecting high-dose vitamin D supply to the United Kingdom.

No MeSH data available.


Related in: MedlinePlus

Serum alkaline phosphatase (•), corrected calcium (▴), and phosphate (▿) for the index patient. Horizontal lines show upper and lower limits of normal ranges for all variables. Alkaline phosphatase increased over time (linear component, r2 = 0.46, F1,28 = 23.9, p = 0.000037).
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Figure 1: Serum alkaline phosphatase (•), corrected calcium (▴), and phosphate (▿) for the index patient. Horizontal lines show upper and lower limits of normal ranges for all variables. Alkaline phosphatase increased over time (linear component, r2 = 0.46, F1,28 = 23.9, p = 0.000037).

Mentions: We investigated her for a mildly but persistently elevated alkaline phosphatase, with intermittently low phosphate and calcium (Figure 1). Her albumin, bilirubin, alanine aminotransferase (ALT), and renal function were normal. Bone and liver isoforms of alkaline phosphatase were not measured. The diagnosis of osteomalacia was confirmed when in April 2008 her serum 25-hydroxyvitamin D level was found to be 10.5 nM, representing severe deficiency (Figure 2A). Coeliac serology was negative. She was commenced on calcium and vitamin D supplementation but fell and suffered a subcapital fracture of her femoral neck later that night, requiring hemiarthroplasty, subsequently complicated by pneumonia, wound infection, urinary tract infection, sepsis, recurrent hemiarthroplasty dislocation and prosthesis infection requiring excision arthroplasty.


Osteomalacia and vitamin D deficiency in a psychiatric rehabilitation unit: case report and survey.

Cardinal RN, Gregory CA - BMC Res Notes (2009)

Serum alkaline phosphatase (•), corrected calcium (▴), and phosphate (▿) for the index patient. Horizontal lines show upper and lower limits of normal ranges for all variables. Alkaline phosphatase increased over time (linear component, r2 = 0.46, F1,28 = 23.9, p = 0.000037).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2683864&req=5

Figure 1: Serum alkaline phosphatase (•), corrected calcium (▴), and phosphate (▿) for the index patient. Horizontal lines show upper and lower limits of normal ranges for all variables. Alkaline phosphatase increased over time (linear component, r2 = 0.46, F1,28 = 23.9, p = 0.000037).
Mentions: We investigated her for a mildly but persistently elevated alkaline phosphatase, with intermittently low phosphate and calcium (Figure 1). Her albumin, bilirubin, alanine aminotransferase (ALT), and renal function were normal. Bone and liver isoforms of alkaline phosphatase were not measured. The diagnosis of osteomalacia was confirmed when in April 2008 her serum 25-hydroxyvitamin D level was found to be 10.5 nM, representing severe deficiency (Figure 2A). Coeliac serology was negative. She was commenced on calcium and vitamin D supplementation but fell and suffered a subcapital fracture of her femoral neck later that night, requiring hemiarthroplasty, subsequently complicated by pneumonia, wound infection, urinary tract infection, sepsis, recurrent hemiarthroplasty dislocation and prosthesis infection requiring excision arthroplasty.

Bottom Line: Vitamin D deficiency is common and predisposes to many serious diseases, yet often goes unrecognized.We describe a case of severe vitamin D deficiency with osteomalacia in a patient resident in a psychiatric hospital for more than 35 years, and discuss causes and complications.We assayed the serum 25-hydroxyvitamin D levels of all patients under our care on one old-age psychiatry rehabilitation unit.

View Article: PubMed Central - HTML - PubMed

Affiliation: Behavioural and Clinical Neurosciences Institute and Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK. rudolf.cardinal@pobox.com

ABSTRACT

Background: Vitamin D deficiency is common and predisposes to many serious diseases, yet often goes unrecognized.

Findings: We describe a case of severe vitamin D deficiency with osteomalacia in a patient resident in a psychiatric hospital for more than 35 years, and discuss causes and complications. We assayed the serum 25-hydroxyvitamin D levels of all patients under our care on one old-age psychiatry rehabilitation unit. Ten of twelve (83%) of patients had vitamin D deficiency, and 92% had suboptimal vitamin D levels. Vitamin D status was strongly predicted by dietary supplementation. Of those not on vitamin D supplements, 100% had vitamin D deficiency, with vitamin D levels significantly below those of historical controls. Age, sex, and duration of admission did not predict vitamin D status in this group.

Conclusion: We advocate vitamin D screening in all patients admitted to psychogeriatric units, and discuss treatment options given the current problems affecting high-dose vitamin D supply to the United Kingdom.

No MeSH data available.


Related in: MedlinePlus