[Osteomalacia with fatal outcome in an elderly patient].
METHODS
A 63-year-old woman was admitted with diffuse bone pain, chest deformity and orthopnea. She had previous prolonged periods of bed rest and decreased sunlight exposure after several bone fractures.


METHODS
Laboratory tests showed hypocalcemia, hypophosphatemia with secondary hyperparathyroidism. The 25-hydroxy-D-vitamin level was too low for measurement. Radiological investigations raised the possibility of metabolic bone disease with secondary fracture. (99m)Tc-MDP bone scintigraphy demonstrated pathological isotope accumulation in places typical for osteomalacia. The histological investigation of the bone showed a thickening of the osteoid substance.


METHODS
Osteomalacia was diagnosed. Two weeks of administering of daily 3000 I.U. vitamin D and 1500 mg calcium normalised the serum level of calcium and phosphate. Because of orthopnea and bone pain the patient stayed in the bed, and had to be given her nadroparin calcium. After six weeks heart and respiratory failure occurred. The patient died from a subtotal pulmonary embolism, which was a consequence of a deep vein thrombosis of the leg.


CONCLUSIONS
In elderly people chronic and serious vitamin D deficiency can cause a life-threatening condition which can be prevented by vitamin D and calcium administration.
Szigeti
N
N
II. Klinik für Innere Medizin und Nephrologisches Zentrum, Medizinischen Universität, Pécs, Hungary. nora.szigeti@aok.pte.hu
Fehér
E
E
Fábián
G
G
D001842:Bone and Bones / Q000000981:diagnostic imaging; D002118:Calcium / Q000008:administration & dosage / Q000627:therapeutic use*; D017809:Fatal Outcome; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology; D006801:Humans; D006996:Hypocalcemia / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D017674:Hypophosphatemia / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D008875:Middle Aged; D010018:Osteomalacia / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D011859:Radiography; D011877:Radionuclide Imaging; D014807:Vitamin D / Q000008:administration & dosage / Q000627:therapeutic use*; D014808:Vitamin D Deficiency / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*
D014807:Vitamin D; D002118:Calcium