Cases reported "Vitamin D Deficiency"

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11/18. 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.
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12/18. 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.
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13/18. 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.
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14/18. 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.
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15/18. 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.
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16/18. 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.
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17/18. 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.
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18/18. Consequences of long-term hyperparathyroidism.

    We describe a young woman with long-term untreated hyperparathyroidism with a superimposed vitamin d deficiency and an extremely decreased bone mineral density that was complicated by a vertebral fracture. Despite pretreatment with intravenous pamidronate and short-term vitamin D supplementation, severe and long-standing hypocalcaemia ('hungry bone syndrome') developed after parathyroidectomy. We discuss the consequences of hyperparathyroidism, especially the effects on bone, the complications of parathyroidectomy and the possibilities of preoperative treatment with bisphosphonates.
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