Osteomalacia in a hemodialysis patient receiving an active vitamin D sterol.

Background: A 17-year-old Filipino male hemodialysis patient presented for renal transplant evaluation. He had significant skeletal abnormalities characterized by bone pain, an inability to walk, and secondary hyperparathyroidism despite therapy with an active vitamin D sterol (paricalcitol).

Investigations: The patient underwent a physical examination, and his serum levels of calcium, phosphorus, alkaline phosphatase, parathyroid hormone, aluminum and 25-hydroxycholecalciferol (25OH-vitamin D) were determined. X-rays of hips and lower extremities, MRI, and bone histomorphometry after double tetracycline labeling were performed.

Diagnosis: Osteomalacia associated with low 25OH-vitamin D levels.

Management: Monthly therapy with ergocalciferol (vitamin D2) and discontinuation of paricalcitol.