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Adult osteomalacia (rickets) pain in an individual relieved by vitamin D, etc. – May 2013

Adult osteomalacia, A treatable cause of "fear of falling"

The left hand x-ray suggested the diagnosis of osteomalacia because of the diffuse demineralization.No image specified. One of the following parameters must be set: fileId, randomGalleryId, fgalId, attId, id, or src.

A 65-year-old man was hospitalized with a gait disorder, obliging him to shuffle laterally1 (video on the Neurology® Web site at www.neurology.org) because of pain and proximal limb weakness.

He had a gastrectomy for cancer 7 years previously, with severe vitamin D deficiency; parathormone and alkaline phosphatase were increased, with reduced serum and urine calcium and phosphate.

There was reduced bone density (figure). He was mildly hypothyroid and pancytopenia B12 and folate levels were normal. Investigation for an endocrine neoplasm (CT scan, Octreoscan) was negative.
EMG of proximal muscles was typical for chronic myopathy; nerve conduction studies had normal results.
After 80 days' supplementation with calcium, vitamin D, and levothyroxine, the patient walked properly without assistance (video); pancytopenia and alkaline phosphatase improved.

From the Department of Neurology, University of Turin (P.R.), and Department of Neurology, University of Eastern Piedmont (E.T., E.B., R.C.), AOU Maggiore della Carita, Novara, Italy.
Author contributions: Dr. Ripellino: acquisition of data, video included; analysis and interpretation of data; writing and editing of the manuscript and of the video. Dr. Terazzi: analysis and interpretation of data. Dr. Bersano: analysis and interpretation of data. Dr. Cantello: study supervision. Study funding: No targeted funding reported.
Disclosure: Dr. Ripellino, Dr. Terazzi, and Dr. Bersano report no disclosures. Dr. Cantello has received a research grant from UCB International and a chairmanship fee from Glaxo Wellcome Italy. .
1. Kurlan R. "Fear of falling" gait: a potentially reversible psychogenic gait disorder. Cogn Behav Neurol 2005;18:171-172.
2. Reginato AJ, Falasca GF, Pappu R, McKnight B, Agha A. Musculoskeletal manifestations of osteomalacia: report of 26 cases and literature review. Semin Arthritis Rheum 1999;28:287-304.
Supplemental data at www.neurology.org
Correspondence to Dr. Ripellino:pao.ripe@hotmail.it
© 2013 American Academy of Neurology 2079


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2525 Osteomalacia.pdf admin 28 May, 2013 140.55 Kb 918