[Osteomalacia with fatal outcome in an elderly patient]

Abstract

History and admission findings: 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.

Investigations: 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.

Diagnosis, treatment and course: 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.

Conclusion: 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.