A Case of Low Bone Mineral Density with Vitamin D Deficiency Due to Prolonged Lactation and Severe Malnutrition

Abstract

Malnutrition associated vitamin D deficiency contributes to the calcium loss from bone and results in osteoporosis and osteomalacia at final stage. Osteomalacia is characterized with softening of bone secondary to defective bone mineralization. Here, we report a case of possible osteomalacia caused by prolonged lactation and severe malnutrition in 35-year-old female. She was a housewife and her body mass index was 11.8 kg/m2. She was diagnosed with severe osteoporosis in regular health check-up 2 years ago, but did not take any medication. Nine months ago, she had been treated with anti-tuberculosis medications for 6 month due to active pulmonary tuberculosis. After complete remission of pulmonary tuberculosis, she had lost her appetite severely. Furthermore, she felt gait difficulty and suffered from generalized bone pain. On serologic examination, hypocalcemia, hypophosphatemia, high alkaline phosphatase, low vitamin D3 and high parathyroid hormone level were seen. In the bone mineral density, Z-score from her lumbar spine was -6.5. She was treated with oral calcium and vitamin D3 intramuscularly. After 1 year treatment, she felt significant improvement in bone pain and could walk alone. Also her serum calcium, phosphate and vitamin D3 level are all normalized.

Correlation analysis between 25-hydroxyvitamin D3, vitamin B12 and vitamin C and endothelial function of patients with CHD

“…Hcy is an intermediate product of the metabolism of methionine and cysteine and cannot be synthesized in human body. Hcy has to be formed after methylation of methionine in food by ingesting food (11). After demethylation, methionine in the food is converted to Hcy (11).…”

“…Hcy has to be formed after methylation of methionine in food by ingesting food (11). After demethylation, methionine in the food is converted to Hcy (11). Therefore, abnormal metabolic process may lead to the accumulation of Hcy, and excessive Hcy can also enter blood circulation (12) to damage vascular endothelial cells, resulting in the excessive growth of vascular smooth muscle cells and over-reaction of the inflammatory system, thereby obstructing lipid metabolism, and inducing vascular endothelial dysfunction and atherosclerosis (13).…”

Medical diagnostic methods applied to a medieval female with vitamin D deficiency from the north of Spain

“…The skeleton described here shows a curvature of the long bones of the lower extremities and absence of pseudofractures, consistent with infantile rickets. However, it should be noted that clinical cases in which vitamin D deficiency is present in adults do not always show pseudofractures (Azad et al 2012;El-Sagheer et al 2016;Rai and Rai 2016;Shin et al 2015), and skeletal deformations have also been noted (Cañas and Iglesias 2005;Chalmers et al 1967;Watanabe et al 2015). This suggests that, although pseudofractures are considered to be pathognomonic of osteomalacia, they are not essential in all cases, and vitamin D deficiency may occur without them.…”

Osteoporosis in Patients With Respiratory Diseases

“…Primary pulmonary tuberculosis mainly led to malnutrition and further induced decreased bone mass in patients ( Rose et al, 1999 ; Ishii et al, 2007 ). Vitamin D deficiency played an important role in tuberculosis-induced osteoporosis ( Shin et al, 2015 ). Vitamin D receptor was regarded as a linkage between tuberculosis and osteoporosis ( Roy et al, 1999 ).…”

“…IL-1 and TNF-α secretion induced by Mycobacterium tuberculosis also involved in the disorder of bone metabolism, leading to bone mass loss ( Wright and Friedland, 2004 ; Yi et al, 2018 ). As for treatment, oral calcium and Vitamin D intake were positive for improving bone mass during tuberculosis ( Shin et al, 2015 ).…”