Osteomalacia is a disorder of inadequate or delayed mineralization of newly formed osteoid (bone protein matrix) in mature bones. Vitamin D deficiency as the cause of this bone abnormality is still common worldwide but is rare in the United States due to adequate sunlight exposure and to fortification of dairy foods with vitamin D. Cases of osteomalacia diagnosed in this country typically occur in the setting of elderly, homebound, severely debilitated individuals. We report a unique case of vitamin D deficiency and osteomalacia in a woman with a medical history significant only for 30 years of IV heroin abuse. A 54 year old female presented to the emergency room with complaints of bone pain, muscle cramping and an ulcer on her right hip. Her only underlying medical problem was 30 years of IV drug abuse which had escalated to the point where she stayed in bed due to “pain” and her husband brought her food and drugs. She was admitted to the hospital for debridement of a right ischial ulcer. Further laboratory workup revealed the following: (Table)
Radiologic evaluation showed diffuse osteopenia, pseudofractures or Looser's zones, as well as true fractures. These dramatic X-rays will be presented along with a discussion of this exceptional case. This report establishes that any cause of prolonged sunlight deprivation, including debilitating narcotic dependency, can result in clinically significant osteomalacia.
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