http://www.laeger.dk/lf/UFL/ufl99_00/1999_2000/ufl9917/v_p/25538.htm vitamin D deficiency Henning G

http://www.laeger.dk/lf/UFL/ufl99_00/1999_2000/ufl9917/v_p/25538.htm vitamin D deficiency Henning Glerup & Erik Fink Eriksen Summary Based on five case histories presented the typical clinical picture seen in osteomalacia and heavy vitamin D deficiency. Symptom The image, which is characterized by little total number of countries in the world diffuse complaints with deep bone pain and alternating muscle aches, often misread as malignancy or rheumatological disease. It argues for a simple workup of three blood tests: total number of countries in the world S-25-hydroxyvitamin-D, S-PTH and S-alkaline phosphatase, which together with the typical clinical picture will reveal virtually all require treatment vitamin D deficiency states. Special risk groups: the elderly> 70 years, total number of countries in the world those with low direct soleksposition, gastroenterological patients total number of countries in the world with malabsorption or gastric / tarmresektioner and people on anticonvulsant therapy. Important differential diagnoses are reviewed. There is proposed a treatment regimen total number of countries in the world consisting of a daily oral calcium 1,000-1,500 mg + 1000 IU of vitamin D in patients with isolated total number of countries in the world low S-25-hydroxyvitamin D (<20 nmol / L), which at the same time the influence of S PTH and / or S-alkaline total number of countries in the world phosphatase supplemented with ergocalciferol 100,000 IU im or po per week for a month. The clinical picture of osteomalacia subject of vitamin D deficiency is characterized by a number of non-specific symptoms that often lead to the diagnosis being overlooked. The result will often be that other diagnoses such as rheumatic disease, polymyalgia rheumatica, fibromyalgia, hysteria shape convulsions, hyperventilation, total number of countries in the world psychiatric disorder or any malignancy primarily considered. To illustrate this we will examine five typical case histories. Subsequently, we will review the clinical findings of severe vitamin D deficiency. Finally, we show that by using a few simple test can easily diagnose correctly and thereby ensure that patients receive the right treatment, which incidentally is cheap and very effective. Case Histories I. A 64-year-old woman was referred for medical endocrinology department for investigation of osteoporosis. The patient had eight years' history total number of countries in the world of arthritis like pain in the muscles in the neck and shoulder-yoke, both femora and crura. Over a year before the current admission, she had had both a spontaneous fracture of a big toe, partly a spontaneous convergence of L 5th Table 1 Blood samples before and after three months of vitamin D treatment. Ca (corr.) (2, 20-2, 52 mmol / L) 25-S--vit- D 1) (20 to 80 nmol / l) S-1, 25 vitD 2) (40 160 pmol / L S-Bas. Fosf. 3) (80 to 275 U / L) S-PTH (1,3-7.6 pmol / l) S-phosphate (0,8- 1.5 mmol / L) Ca duplex ( <7 mmol / day) duplex hybrid droxy- proline (60 to 190 mmol / day) Case history no. 1 before be-action 2.09 <5 49 559 17.8 0.8 1.8 277 after three months 2 , 44 49 169 310 1.5 1.2 Medical history no. 2 before be-action 2.30 5 118 501 12.1 0.7 3.3 173 after three months 2.44 33> 250 302 1.9 1, 0 Case history no. 3 before be-action 2.08 7 30 750 23 0.8 6.0 593 after three months 2.34 75 160 415 13 1.2 Case history no. 4 before be-action 2.20 6 27 397 32.4 1.1 after three months 2.34 36,105,252 5.1 Case history no. 5 before be-action 1.25 <5 102 591 19.8 1.2 0.6 248 after three months total number of countries in the world 2.19 24 135 314 5.7 1.3 1) hydroxyvitamin-D. 2) Hydroxy 2 vitamin-D. 3) Alkaline total number of countries in the world phosphatase. dU = days urine. On admission, the patient complained of strong total number of countries in the world respirationssynkrone pain in the lower costae of woe. side, in addition seizure tendency and pain in the calf muscles and føleforstyrelser with paresthesia in both crura and feet. The patient's gait was greatly total number of countries in the world reduced, so that she could barely able to walk with a cane and can not easily cope with climbing stairs. Paraclinically there were marginally reduced serum calcium, highly elevated total number of countries in the world PTH and S-alkaline phosphatase (Table 1). QDR-scan showed total number of countries in the world decreased bone mineral density (bone mineral density [BMD]) in both the lumbar total number of countries in the world spine as hip (Table 2). It was performed bone biopsy am Bordier, who showed increased incidence of non-mineralized osteoid. Based on knoglebiopsien style led by the applicable criteria (1, 2) diagnosis of osteomalacia. total number of countries in the world Were initiated treatment with calcium (tabl. Calcichew-D 3) 1 '3 and alfacalcidolkapsler (Etalpha) 0.5 mg daily. After three months of treatment, the patient laboratorietal total number of countries in the world all normalized with the exception of alkaline total number of countries in the world phosphatase, which is a marginal increase. Clinically, the patient improved significantly: pain almost completely gone and time function total number of countries in the world normalized total number of countries in the world so that the patient is now free to climb stairs. Table 2 Bone mineral density (BMD) before and after three months of vitamin D treatment.
Hip Z-score Case history no. 1 before be-action 0.603 3.80 1.53 0.554 3.05 1.56 after one year 0.747 1.93 0.01 0.613 2.56 1.01 Case history no. 3 before buy mental action 0.754 3.13 2.27 0.522 3.83 2.75 after one year 0.825 2.54 1.73 0.664