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Severe Osteomalacia Related to Long-Term Intravenous Drug Abuse.

Gamache L, Burge MR - J Investig Med High Impact Case Rep (2014)

Bottom Line: She had been bed bound for approximately 1 year secondary to pain of uncertain etiology, and her husband was bringing her both food and drugs.Radiologic evaluation demonstrated diffuse osteopenia with pseudofractures, as well as true fractures.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Health One, Denver Endocrinology, Denver, CO, USA.

ABSTRACT
Objective. We present the clinical, biochemical, and imaging findings of a woman with vitamin D deficiency and severe osteomalacia related to intravenous heroin addiction. Results. A 54-year-old woman with a medical history significant for long-standing heroin abuse presented with complaints of bone pain, muscle cramping, and a left hip ulcer. She had been bed bound for approximately 1 year secondary to pain of uncertain etiology, and her husband was bringing her both food and drugs. She was admitted to the hospital for debridement of a right ischial ulcer. Further workup revealed osteomyelitis of the left hip and severe vitamin D deficiency. Radiologic evaluation demonstrated diffuse osteopenia with pseudofractures, as well as true fractures. Conclusion. This is the first case reported in the English literature of advanced osteomalacia resulting from a debilitating narcotic dependency. Vitamin D deficiency should be considered in patients with poor nutrition and prolonged sunlight deprivation from any cause.

No MeSH data available.


Related in: MedlinePlus

A radiograph of the distal femurs shows further evidence of badly malformed bones secondary to severe osteomalacia (large arrow), as well as several additional pseodofractures (small arrows).
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fig4-2324709614548797: A radiograph of the distal femurs shows further evidence of badly malformed bones secondary to severe osteomalacia (large arrow), as well as several additional pseodofractures (small arrows).

Mentions: A series of radiographs demonstrated the dramatic bone changes of osteopenia and osteomalacia. An anteroposterior radiograph of the right tibia and fibula (Figure 1) shows striking osteopenia of both bones. Several pseudofractures (also known as “Looser zones”) are present, the most prominent of which is the buckle-type fracture at the distal diaphysis of the tibia. A radiograph of the left lateral forearm (Figure 2) also showed marked bony demineralization. There were fractures at various stages of healing as evidenced by callous formation at an old fracture site and by sharp margins at an acute fracture. A lateral view of the left tibia and fibula (Figure 3) again show severely osteopenic and gracile bones. The outline of the fibula is barely visible because of the lack of cortical bone. Fractures involving the mid-tibial and mid-fibular shafts are also seen, but age assessment of these injuries is compromised because of the severe osteopenia. A radiograph of the distal femurs (Figure 4) shows badly misshapen bone and several additional pseudofractures attributable to severe osteomalacia.


Severe Osteomalacia Related to Long-Term Intravenous Drug Abuse.

Gamache L, Burge MR - J Investig Med High Impact Case Rep (2014)

A radiograph of the distal femurs shows further evidence of badly malformed bones secondary to severe osteomalacia (large arrow), as well as several additional pseodofractures (small arrows).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4528900&req=5

fig4-2324709614548797: A radiograph of the distal femurs shows further evidence of badly malformed bones secondary to severe osteomalacia (large arrow), as well as several additional pseodofractures (small arrows).
Mentions: A series of radiographs demonstrated the dramatic bone changes of osteopenia and osteomalacia. An anteroposterior radiograph of the right tibia and fibula (Figure 1) shows striking osteopenia of both bones. Several pseudofractures (also known as “Looser zones”) are present, the most prominent of which is the buckle-type fracture at the distal diaphysis of the tibia. A radiograph of the left lateral forearm (Figure 2) also showed marked bony demineralization. There were fractures at various stages of healing as evidenced by callous formation at an old fracture site and by sharp margins at an acute fracture. A lateral view of the left tibia and fibula (Figure 3) again show severely osteopenic and gracile bones. The outline of the fibula is barely visible because of the lack of cortical bone. Fractures involving the mid-tibial and mid-fibular shafts are also seen, but age assessment of these injuries is compromised because of the severe osteopenia. A radiograph of the distal femurs (Figure 4) shows badly misshapen bone and several additional pseudofractures attributable to severe osteomalacia.

Bottom Line: She had been bed bound for approximately 1 year secondary to pain of uncertain etiology, and her husband was bringing her both food and drugs.Radiologic evaluation demonstrated diffuse osteopenia with pseudofractures, as well as true fractures.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Health One, Denver Endocrinology, Denver, CO, USA.

ABSTRACT
Objective. We present the clinical, biochemical, and imaging findings of a woman with vitamin D deficiency and severe osteomalacia related to intravenous heroin addiction. Results. A 54-year-old woman with a medical history significant for long-standing heroin abuse presented with complaints of bone pain, muscle cramping, and a left hip ulcer. She had been bed bound for approximately 1 year secondary to pain of uncertain etiology, and her husband was bringing her both food and drugs. She was admitted to the hospital for debridement of a right ischial ulcer. Further workup revealed osteomyelitis of the left hip and severe vitamin D deficiency. Radiologic evaluation demonstrated diffuse osteopenia with pseudofractures, as well as true fractures. Conclusion. This is the first case reported in the English literature of advanced osteomalacia resulting from a debilitating narcotic dependency. Vitamin D deficiency should be considered in patients with poor nutrition and prolonged sunlight deprivation from any cause.

No MeSH data available.


Related in: MedlinePlus