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Vitamin D deficiency osteomalacia — SCE Endocrinology MCQ

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HardCalcium/BoneVitamin D deficiency osteomalaciaSCE Endocrinology

A 72-year-old man has bone pain, proximal weakness and recurrent falls. Calcium is 2.12 mmol/L, phosphate 0.58 mmol/L, alkaline phosphatase is raised and 25-hydroxyvitamin D is 18 nmol/L. PTH is raised. What is the most likely biochemical finding after treatment begins?

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Correct answer: E — Transient fall in calcium risk during vitamin D repletion if bone hunger is marked

Transient fall in calcium risk during vitamin D repletion if bone hunger is marked is best because severe vitamin D deficiency osteomalacia with secondary hyperparathyroidism may develop transient hypocalcaemia during remineralisation. The alternatives are less appropriate because ALP and PTH improve gradually; phosphate may take time to normalise; one dose does not permanently suppress PTH; calcitonin is not the key adaptation. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE CKS Vitamin D deficiency; NOGG osteoporosis guideline