11/21. Hypocalcemic seizures and secondary bilateral femoral fractures in an adolescent with primary vitamin d deficiency.Nutritional rickets and osteomalacia are reemerging in Western societies, particularly in young children and in adolescents of African or Asian descent. Hypocalcemic seizures resulting from vitamin d deficiency are rare in adolescents, whereas fractures caused by seizures without evidence of direct trauma have not yet been reported in this population. We present an unusual case of secondary bilateral femoral fractures caused by hypocalcemic seizures in a 17-year-old boy with primary vitamin d deficiency. We examine the epidemiology and the clinical presentation of rickets and osteomalacia in the adolescent population, the risk of secondary injuries in patients with seizures, and the evaluation and management of hypocalcemic seizures and primary vitamin d deficiency.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
12/21. Primary sjogren's syndrome with secondary hyperparathyroidism.The case history of a 43-year-old woman with primary sjogren's syndrome is presented: in 1970, xerostomia and keratoconjunctivitis sicca; in 1980, arthritis; in 1982, chronic tubulointerstitial nephritis with renal tubular acidosis and vasopressin-resistant hyposthenuria. The renal function gradually deteriorated. Chronic atrophic gastritis with vitamin B12 deficiency and chronic duodenitis with diminished disaccharidase activity in the mucosa were also diagnosed. From 1985, repeated multiple fractures of the ribs occurred, with secondary hyperparathyroidism in the background. The renal and intestinal involvement suggests that, besides the elevated parathyroid hormone level, an acquired vitamin d deficiency plays a pathogenetic role in severe osteopenia. The patient is being treated at present by haemodialysis, and subtotal parathyroidectomy and renal transplantation are planned.- - - - - - - - - - ranking = 0.16666666666667keywords = fracture (Clic here for more details about this article) |
13/21. Severe vitamin d deficiency in a case of primary hyperparathyroidism caused by parathyroid lipoadenoma, effect of 25OHD3 treatment.This report describes the case of a 60-year-old woman with severe metabolic bone disease and fractures due to vitamin d deficiency and hyperparathyroidism. 25OHDH3 and 1,25(OH)2D3 serum levels were undetectable and increased immediately following 25OHD3 oral administration. serum 1,25(OH)2D3 following vitamin D repletion reached values above the normal range, and remained elevated with strict dependence on the serum 25OHD3 levels. parathyroid hormone and alkaline phosphatase decreased during treatment, without reaching normality during 1 year of observation. Bone biopsies before and after 8-month 25OHD3 treatment showed disappearance of the osteomalacic and hyperparathyroid lesions. During treatment an increase in serum and urine calcium and formation of renal stones were observed. The patient underwent neck exploration with the finding and removal of a lipoadenoma, a rare parathyroid tumor, followed by complete and permanent remission of the disease. In conclusion, this case is suggestive of the key role played by the long-term vitamin D status in the clinical expression of primary hyperparathyroidism.- - - - - - - - - - ranking = 0.16802288256356keywords = fracture, neck (Clic here for more details about this article) |
14/21. Prevention of hip fractures.The effort to identify elderly people at high risk of hip fracture can reasonably focus on patients who are prone to falling (identified by several criteria, including a history of falling) and perhaps those who are likely to be the most osteopenic. Efforts at treatment must be individualized. Increased use of estrogens by women now going through menopause may improve the statistics on hip fracture, beginning 10 to 20 years from now. Meanwhile, the tailoring of interventions in elderly people to prevent falls, to counter osteoporosis, and to identify and treat correctable causes of osteopenia may produce a more immediate improvement in the statistics.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
15/21. osteomalacia in a night nurse.A 41-year-old nurse, regularly employed on the night shift, complained of generalized bone pain and tenderness, pathologic pseudofractures, and the inability to walk. She assiduously avoided sunlight and dairy products and habitually ingested barbiturates. A low-serum 25-hydroxyvitamin D (25-OH-D) level reflected her low total body store of vitamin D. A biopsy revealed osteomalacia. Years of marginal dietary vitamin D intake, along with lack of sun exposure and habitual use of phenobarbital, were possible multifactorial causes of the osteomalacia. Her symptoms completely disappeared with vitamin D and calcium treatment. Although classical vitamin d deficiency is now rare in Western nations of the world, patients with generalized bone pain should be thoroughly investigated with respect to diet, medication, and occupational conditions contributing to osteomalacia.- - - - - - - - - - ranking = 0.16666666666667keywords = fracture (Clic here for more details about this article) |
16/21. Bilateral fracture of the femoral neck during a hypocalcaemic convulsion. A case report.vitamin d deficiency occurs in up to 24% of the Asian immigrant population in the United Kingdom, but pathological fractures are relatively uncommon. We report a case of bilateral fracture of the femoral neck caused by a convulsion secondary to dietary-induced hypocalcaemia. To our knowledge such a sequence has not previously been reported.- - - - - - - - - - ranking = 16.299363314575keywords = femoral neck, fracture, neck (Clic here for more details about this article) |
17/21. Nutritional hypovitaminosis-D and the genesis of osteomalacia in the elderly.A review is presented of the genesis of osteomalacia due to dietary lack of vitamin D in the elderly in the United Kingdom. Subjects at high risk are identified and the diagnostic difficulties discussed. The importance of dietary vitamin D and exposure to sunlight in relation to vitamin status is stressed. The role of vitamin D in calcium metabolism is now much more clearly defined; the final active form of the vitamin is 1,25-dihydroxy-vitamin D, which acts like a hormone after the vitamin molecule has undergone two chemical modifications in the liver and kidney. A correlation between lack of vitamin D and femoral neck fractures has been established. Six illustrative cases of osteomalacia in the elderly due to dietary lack of vitamin D are reported.- - - - - - - - - - ranking = 29.391232157738keywords = femoral neck fracture, neck fracture, femoral neck, fracture, neck (Clic here for more details about this article) |
18/21. calcitriol deficiency in idiopathic juvenile osteoporosis.Low plasma calcitriol (1,25-dihydroxycholecalciferol) and normal serum calcifediol (25-hydroxycholecalciferol) levels were noted during the evaluation of an 11-year-old girl with diffuse osteoporosis and pathologic fractures. The onset of osteoporosis prior to puberty and the characteristic metaphyseal location of the fractures supported the diagnosis of idiopathic juvenile osteoporosis (IJO). Treatment with calcitriol, 1.0 microgram daily, was associated with bone mineral accretion and a diminished incidence of fractures. plasma calcitriol levels returned to normal when the disease resolved following puberty. This experience suggests a relationship between calcitriol deficiency and the pathogenesis of IJO.- - - - - - - - - - ranking = 0.5keywords = fracture (Clic here for more details about this article) |
19/21. Postgastrectomy osteomalacia with pseudofractures assessed by repeated bone scintigraphy.A patient with osteomalacia secondary to vitamin d deficiency after gastrectomy for gastric cancer is presented. Initial bone scintigrams showed both asymmetric and symmetric focal areas of intense uptake due to pseudofractures reminiscent of bone metastases. Radiographs only confirmed the presence of pseudofractures at some, but not all, of the abnormal sites demonstrated by bone scintigraphy. At first, metastatic bone disease was suspected. However, the appearance of repeated bone scintigram was normalized after treatment with vitamin D. A diagnosis of osteomalacia was established. The present case serves to illustrate that symmetric focal lesions are important features of pseudofractures secondary to osteomalacia, and comparison with radiographs and repeated bone scintigraphy are necessary in distinguishing between bone metastases and pseudofractures.- - - - - - - - - - ranking = 1.3333333333333keywords = fracture (Clic here for more details about this article) |
20/21. Neonatal primary hyperparathyroidism masked by vitamin d deficiency.Neonatal primary hyperparathyroidism is a life threatening disorder that is associated with severe hypercalcaemia, hypotonia, bone demineralization, fractures and respiratory distress. Treatment consists of total parathyroidectomy and without this affected infants will usually die by the age of three months. We report a patient with neonatal primary hyperparathyroidism who survived without fractures or parathyroidectomy to an age of nine months, and in whom the hypercalcaemia became masked by vitamin d deficiency. At surgery, four-gland hyperplasia was demonstrated and total parathyroidectomy followed by oral calcitriol treatment has restored well-being and normocalcaemia. An absence of skeletal complications, a survival beyond three months of age without parathyroidectomy and the masking of the hypercalcaemia by vitamin d deficiency represents a unique combination of metabolic abnormalities in a patient with neonatal primary hyperparathyroidism.- - - - - - - - - - ranking = 0.33333333333333keywords = fracture (Clic here for more details about this article) |
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