Cases reported "Vitamin D Deficiency"

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1/2. Posttransplant bone disease: a case illustrating dramatic improvements in bone density with vitamin d replacement therapy.

    Although bisphosponates are proposed as first-line treatment for posttransplant bone disease they are not optimal in all situations. A kidney transplant recipient developed hypercalcemia from mobilization of extraskeletal calcium. He had low serum parathyroid hormone and vitamin d; high calcium excretion; and normal calcium intake. Bone biopsy revealed severe osteomalacia. Bisphosphonates, used in the early treatment of acute hypercalcemia, were not indicated to treat osteomalacia. However, over several months serum calcium declined sufficiently to allow treatment of the bone disease with oral calcitriol. Dual-energy radiographic absorptiometry over the next 2 years documented dramatic improvements in bone density (percent of young-normal controls) : from 63 to 85%, at the lumbar spine; from 38 to 67%, at the femoral neck. This response to treatment could not have been achieved with an antiresorptive strategy. Optimal management of posttransplant bone disease requires a diagnostic approach, which considers all plausible contributing factors.
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2/2. 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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