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  • Case Study
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Osteomalacia in a hemodialysis patient receiving an active vitamin D sterol

Abstract

Background A 17-year-old Filipino male hemodialysis patient presented for renal transplant evaluation. He had significant skeletal abnormalities characterized by bone pain, an inability to walk, and secondary hyperparathyroidism despite therapy with an active vitamin D sterol (paricalcitol).

Investigations The patient underwent a physical examination, and his serum levels of calcium, phosphorus, alkaline phosphatase, parathyroid hormone, aluminum and 25-hydroxycholecalciferol (25OH-vitamin D) were determined. X-rays of hips and lower extremities, MRI, and bone histomorphometry after double tetracycline labeling were performed.

Diagnosis Osteomalacia associated with low 25OH-vitamin D levels.

Management Monthly therapy with ergocalciferol (vitamin D2) and discontinuation of paricalcitol.

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Figure 1: Biochemical indices over time
Figure 2: Radiologic study before treatment
Figure 3: MRI scan of the pelvis (coronal plane)
Figure 4: Radiologic study after treatment

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Acknowledgements

This work was supported in part by NIH Research Project Grants DK675632, DK35423 and RR-00865, and funds from the Casey Lee Ball Foundation. The authors would like to thank William G Goodman for his histomorphometric analyses and interpretations of the patient's bone biopsies.

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Correspondence to Isidro B Salusky.

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Competing interests

IB Salusky has received honorarium from Abbott Laboratories (speakers' bureau) and Genzyme. The other authors declared they have no competing interests.

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Hernandez, J., Wesseling, K., Boechat, M. et al. Osteomalacia in a hemodialysis patient receiving an active vitamin D sterol. Nat Rev Nephrol 3, 227–232 (2007). https://doi.org/10.1038/ncpneph0443

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