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

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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.

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Authors and Affiliations

  1. INSERM U1059, Université de Lyon, 15 Rue A PARE, 42023, Saint-Etienne, Cedex 2, France

    M.-H. Lafage-Proust, L. Vico & T. Thomas

  2. Rheumatology Department, University Hospital, 42055, Saint-Etienne, France

    M.-H. Lafage-Proust, C. Cusset & T. Thomas

  3. Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium

    L. Lieben & G. Carmeliet

  4. Centre d’Imagerie Nucléaire, C.H.P.L., 42000, Saint-Etienne, France

    C. Soler

Authors
  1. M.-H. Lafage-Proust
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  2. L. Lieben
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  3. G. Carmeliet
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  4. C. Soler
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  5. C. Cusset
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  6. L. Vico
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  7. T. Thomas
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Correspondence to M.-H. Lafage-Proust.

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Lafage-Proust, MH., Lieben, L., Carmeliet, G. et al. High bone turnover persisting after vitamin D repletion: beware of calcium deficiency. Osteoporos Int 24, 2359–2363 (2013). https://doi.org/10.1007/s00198-013-2273-1

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  • DOI: https://doi.org/10.1007/s00198-013-2273-1

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