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Vitamin D deficiency osteomalacia — SCE Endocrinology MCQ

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ModerateCalcium/BoneVitamin D deficiency osteomalaciaSCE Endocrinology

A 36-year-old man with Crohn's disease has bone pain and proximal weakness. Calcium is 2.10 mmol/L, phosphate 0.72 mmol/L, ALP is raised, PTH is raised and 25-OH vitamin D is 12 nmol/L. What is the most likely biochemical finding?

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Correct answer: D — Low 25-OH vitamin D with secondary hyperparathyroidism

The biochemical pattern is vitamin D deficiency with secondary hyperparathyroidism and osteomalacia physiology. Primary hyperparathyroidism would typically have high calcium. The pearl is that malabsorption increases vitamin D deficiency risk and ALP can reflect osteomalacia.

Reference: NICE vitamin D guidance, BNF