title: Osteomalacia as a very late manifestation of primary hyperparathyroidism.
abstract: An 86-year-old woman with a history of treated hyperthyroidism and a 20-year history of untreated primary hyperparathyroidism developed generalized bone pain and a pseudofracture of the midshaft of the left femur. Laboratory examinations revealed elevated serum calcium, alkaline phosphatase, and C-terminal parathyroid hormone levels. Serum inorganic phosphate was below normal and 25-hydroxyvitamin D levels were low-normal. An undecalcified transiliac bone biopsy specimen following tetracycline double labeling revealed osteomalacia and osteitis fibrosa. Following treatment with vitamin D and phosphate, the serum inorganic phosphate level rose to normal. There was a decrease in bone pain, and the pseudofracture healed. However, the serum calcium, alkaline phosphatase, and C-terminal parathyroid hormone levels remained elevated. Longstanding primary hyperparathyroidism causes chronic hypophosphatemia and may lead to osteomalacia. Osteomalacia and its consequences may be part of the spectrum of bone disease seen in patients with longstanding primary hyperparathyroidism.
authors.affiliation: Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia.
authors.forename: F S
authors.initials: FS
authors.lastname: Kaplan
authors.forename: S R
authors.initials: SR
authors.lastname: Soffer
authors.forename: M D
authors.initials: MD
authors.lastname: Fallon
authors.forename: J G
authors.initials: JG
authors.lastname: Haddad
authors.forename: M
authors.initials: M
authors.lastname: Dalinka
authors.forename: E C
authors.initials: EC
authors.lastname: Raffensperger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000150:complications* / Q000473:pathology; D010018:Osteomalacia / Q000209:etiology* / Q000473:pathology