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Osteoporosis International

, Volume 24, Issue 8, pp 2359–2363 | Cite as

High bone turnover persisting after vitamin D repletion: beware of calcium deficiency

  • M.-H. Lafage-Proust
  • L. Lieben
  • G. Carmeliet
  • C. Soler
  • C. Cusset
  • L. Vico
  • T. Thomas
Case Report

Abstract

Treatment of vitamin D deficiency with vitamin D is a common procedure when taking care of elderly patients, calcium supplementation being added only when calcium dietary intake is insufficient. Here, we report the case of a 58-year-old female who was referred to our unit because of suspicion of Paget’s disease of the skull, based on elevated serum alkaline phosphatase and high skull methylene diphosphonate-technetium uptake. She had been prescribed cholecalciferol (100,000 IU/month) and calcium salts for the past 7 months after discovery of severe vitamin D deficiency by her primary care physician. No specific skull bone lesions were observed on both X-ray and computerized tomography. Serum calcium, phosphate and 25(OH) vitamin D levels were normal, while serum C-terminal cross-linked telopeptide, bone alkaline phosphatase and calcitriol were high and daily urinary calcium excretion was low. We found that she had not been compliant with the calcium prescription while vitamin D had been thoroughly taken. We suspected osteomalacia due to calcium deficiency. Both skull uptake and biological abnormalities normalised in few months after adding calcium supplementation to the vitamin D treatment, and spine bone mineral density increased by 9.5 % after 14 months of full treatment. The present case illustrates the necessity for adequate calcium intake during vitamin D repletion to normalise bone mineralisation and turnover and maintain the skeletal integrity.

Keywords

Bone alkaline phosphatase Calcium deficiency Osteomalacia 

Notes

Conflicts of interest

None.

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • M.-H. Lafage-Proust
    • 1
    • 2
  • L. Lieben
    • 3
  • G. Carmeliet
    • 3
  • C. Soler
    • 4
  • C. Cusset
    • 2
  • L. Vico
    • 1
  • T. Thomas
    • 1
    • 2
  1. 1.INSERM U1059Université de LyonSaint-EtienneFrance
  2. 2.Rheumatology DepartmentUniversity HospitalSaint-EtienneFrance
  3. 3.Clinical and Experimental EndocrinologyKU LeuvenLeuvenBelgium
  4. 4.Centre d’Imagerie NucléaireC.H.P.L.Saint-EtienneFrance

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