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Vitamin D metabolism and bone histomorphometry in a patient with antacid-induced osteomalacia

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      Abstract

      A patient with hypophosphatemic osteomalacia secondary to ingestion of large amounts of phosphate-binding antacids is presented. Vitamin D metabolites were measured during the course of his illness and recovery and demonstrated an initially elevated concentration of 1,25-dihydroxyvitamin D, an undetectable level of 24,25-dihydroxyvitamin D, and a normal level of 25-hydroxyvitamin D. These metabolites returned to normal levels when the hypophosphatemia was corrected. Bone histomorphometry showed osteomalacia with increased resorption. The possible role of altered vitamin D metabolism in the pathogenesis of this disorder is discussed.
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      References

        • Dent CE
        • Winter CS
        Osteomalacia due to phosphate depletion from excessive aluminum hydroxide ingestion.
        Br Med J. 1974; 1: 551-552
        • Lotz M
        • Ney R
        • Bartter F
        Osteomalacia and debility resulting from phosphorus depletion.
        Trans Assoc Am Physicians. 1964; 77: 281-293
        • Cooke N
        • Teitelbaum S
        • Avioli L
        Antacid-induced osteomalacia and nephrolithiasis.
        Arch Intern Med. 1978; 138: 1007-1009
        • Baker L
        • Ackrill P
        • Cattell W
        • Stamp T
        • Watson L
        Iatrogenic osteomalacia and myopathy due to phosphate depletion.
        Br Med J. 1974; 3: 150-152
        • Bloom W
        • Flinchum D
        Osteomalacia with pseudofractures caused by the ingestion of aluminum hydroxide.
        JAMA. 1960; 174: 1327-1330
        • Insogna K
        • Bordley D
        • Caro J
        • Lockwood D
        Osteomalacia and weakness from excessive antacid ingestion.
        JAMA. 1980; 244: 2544-2546
        • Gray R
        • Wilz D
        • Caldas A
        • Lemann J
        The importance of phosphate in regulating plasma 1,25(OH)2 vitamin D levels in humans: studies in healthy subjects, in calcium stone formers and in patients with primary hyperparathyroidism.
        J Clin Endocrinol Metab. 1977; 45: 299-306
        • Insogna KL
        • Broadus AE
        • Gertner JM
        Impaired phosphorus conservation and 1,25 dihydroxyvitamin D generation during phosphorus deprivation in familial hypophosphatemic rickets.
        J Clin Invest. 1983; 71: 1562-1569
        • Gray R
        Effects of age and sex on the regulation of plasma 1,25(OH)2D by phosphorus in the rat.
        Calcif Tissue Int. 1981; 33: 477-484
        • Baylink D
        • Wergsdal J
        • Stauffer M
        Formation, mineralization and resorption of bone in hypophosphatemic rats.
        J Clin Invest. 1971; 50: 2519-2530
        • Castillo L
        • Tanaka Y
        • DeLuca H
        The mobilization of bone mineral by 1,25 dihydroxyvitamin D3 in hypophosphatemic rats.
        Endocrinology. 1975; 97: 995-999
        • Rasmussen M
        • Baron R
        • Broadus A
        • DeFronzo R
        • Lang R
        • Horst R
        1,25(OH)2D3 is not the only D metabolite involved in the pathogenesis of osteomalacia.
        Am J Med. 1980; 69: 360-368