Life-Threatening Hypocalcemia in A Patient with highly suspected osteomalacia: A Case Report

Objective: osteomalacia is a metabolic bone disease characterized by impaired mineralization with increased non-mineralized osteoid tissue, increased frailty, and reduced bone mineral density. a common cause of osteomalacia in adults and the elderly is severe deficiency of vitamin D, which leads to chronic hypocalcemia, hypophosphatemia, and secondary hyperparathyroidism. The objective of this case report is to describe an unusual clinical presentation of osteomalacia, consisting of life-threatening acute hypocalcemia. methods: clinical, laboratory, and imaging data are presented. Results: We report the case of a 65-year-old man that showed symptoms and signs of severe and prolonged hypocalcemia due to unrecognized vitamin D deficiency. he presented at the emergency room reporting abdominal pain and vomiting since the evening before. Blood tests showed increased levels of rhabdomyolysis markers, severe hypocalcemia, hypophosphatemia, hypomagnesemia, normal renal function, elevated levels of alkaline phosphatase, extremely high levels of parathyroid hormone, and hypovitaminosis D. Radiological skeletal features of bone demineralization and bone abnormalities suggestive of osteomalacia were additionally detected. Other secondary causes of hypocalcemia were excluded. clinical and biochemical resolution were progressively obtained only after an intramuscular loading dose of cholecalciferol was added to the standard calcium intravenous replacement therapy. Conclusion: This case report shows that osteomalacia consequent to a severe vitamin D deficiency can present with acute symptoms and signs of severe hypocalcemia requiring hospital admission. In such cases, vitamin D administration, and not intensive calcium supplementation alone, is essential to achieve clinical resolution of symptoms and normalization of mineral metabolism parameters. Abbreviations: 25-OH-D 25-hydroxyvitamin D CT computed tomography IV intravenous PTH parathyroid hormone