Osteoporos Int DOI 10.1007/s00198-015-3102-5
CASE REPORT
A case report of osteomalacia unmasking primary biliary cirrhosis M. Pawlowska & J. E. Kapeluto & D. L. Kendler
Received: 8 November 2014 / Accepted: 4 March 2015 # International Osteoporosis Foundation and National Osteoporosis Foundation 2015
Abstract Osteomalacia, a metabolic bone disease characterized by the inability to mineralize new osteoid, can be caused by vitamin D deficiency. We report a patient with symptomatic, biochemical, and imaging evidence of osteomalacia due to vitamin D deficiency, who as a result of work up for bone disease was diagnosed with early primary biliary cirrhosis. Osteomalacia was treated with high-dose vitamin D and serial bone density scans showed evidence of increasing bone mineral density suggesting osteoid mineralization in response to treatment. The diagnosis of cholestatic liver disease should be considered in all patients presenting with osteomalacia due to vitamin D deficiency, particularly if other cholestatic liver enzymes are elevated in addition to alkaline phosphatase.
is the inability to mineralize newly formed osteoid. Clinically, patients with osteomalacia may complain of bone pain, due to stretching of the periosteum, exhibit an antalgic waddling gait, complain of muscle weakness, and have evidence of low bone density by DXA. Calcium and phosphate levels are commonly in the normal range, but alkaline phosphatase (ALP) is generally elevated [2]. When other cholestatic liver enzymes are elevated, concurrent cholestatic liver disease should be considered. Advanced cholestatic liver disease can cause fat malabsorption and consequently vitamin D malabsorption. As 25(OH) vitamin D levels decrease, calcium absorption is impaired with resulting metabolic bone disease which can progress to osteomalacia.
Keywords Cholestatic liver disease . Metabolic bonedisease . Osteomalacia . PBC . Primary biliary cirrhosis . Secondary hyperparathyroidism . Vitamin D deficiency
Case report
Introduction According to cut points set by the Institute of Medicine (IOM) [1], serum 25(OH)D levels
CASE REPORT
A case report of osteomalacia unmasking primary biliary cirrhosis M. Pawlowska & J. E. Kapeluto & D. L. Kendler
Received: 8 November 2014 / Accepted: 4 March 2015 # International Osteoporosis Foundation and National Osteoporosis Foundation 2015
Abstract Osteomalacia, a metabolic bone disease characterized by the inability to mineralize new osteoid, can be caused by vitamin D deficiency. We report a patient with symptomatic, biochemical, and imaging evidence of osteomalacia due to vitamin D deficiency, who as a result of work up for bone disease was diagnosed with early primary biliary cirrhosis. Osteomalacia was treated with high-dose vitamin D and serial bone density scans showed evidence of increasing bone mineral density suggesting osteoid mineralization in response to treatment. The diagnosis of cholestatic liver disease should be considered in all patients presenting with osteomalacia due to vitamin D deficiency, particularly if other cholestatic liver enzymes are elevated in addition to alkaline phosphatase.
is the inability to mineralize newly formed osteoid. Clinically, patients with osteomalacia may complain of bone pain, due to stretching of the periosteum, exhibit an antalgic waddling gait, complain of muscle weakness, and have evidence of low bone density by DXA. Calcium and phosphate levels are commonly in the normal range, but alkaline phosphatase (ALP) is generally elevated [2]. When other cholestatic liver enzymes are elevated, concurrent cholestatic liver disease should be considered. Advanced cholestatic liver disease can cause fat malabsorption and consequently vitamin D malabsorption. As 25(OH) vitamin D levels decrease, calcium absorption is impaired with resulting metabolic bone disease which can progress to osteomalacia.
Keywords Cholestatic liver disease . Metabolic bonedisease . Osteomalacia . PBC . Primary biliary cirrhosis . Secondary hyperparathyroidism . Vitamin D deficiency
Case report
Introduction According to cut points set by the Institute of Medicine (IOM) [1], serum 25(OH)D levels
