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in her back after lifting a suitcase. A compression fracture
of the T11 vertebral body is identified on x-ray examination.
Routine laboratory evaluation discloses a serum
calcium concentration of 2 mmol/L (8.0 mg/dL), a serum
phosphorus concentration of 0.77 mmol/L (2.4 mg/dL),
and increased serum alkaline phosphatase activity. The
serum parathyroid hormone level was subsequently found
to be elevated as well. The most likely diagnosis is
(A) Paget™s disease of bone
(B) ectopic parathyroid hormone secretion
© primary hyperparathyroidism
(D) postmenopausal osteoporosis
(E) vitamin D deficiency
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jinkai, you are doing good E) vitamin D deficiency
The combination of hypocalcemia, hypophosphatemia, elevated serum parathyroid hormone levels, and bone fractures is consistent with a diagnosis of osteomalacia in this patient.
In the absence of other gastrointestinal or renal abnormalities leading to malabsorption or increased renal loss of calcium or phosphorus, vitamin D deficiency is likely to be present. Inadequate intake of vitamin D and calcium together and limited exposure to the sun are common in this age group.
Postmenopausal osteoporosis is associated with vertebral and hip fractures as well, but
laboratory abnormalities are not present.
Primary hyperparathyroidism is associated with increased serum calcium concentration, as is ectopic parathyroid hormone secretion (although the existence of the latter has been questioned).
Paget™s disease of bone does not produce hypocalcemia, and it causes typical sclerotic changes on x-ray examination.
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In paget's you will finde hypercalcemia.
In osteoporosis, everything is normal including serum calcium level.
