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Effectiveness of intramuscular ergocalciferol treatment in a patient with osteomalacia and insufficiency fractures due to severe vitamin D deficiency after bariatric surgery.

Authors
  • Papanastasiou, Labrini1
  • Gravvanis, Christos1
  • Tournis, Symeon2
  • Markou, Athina1
  • Giagourta, Irene1
  • Lymperopoulos, Konstantinos3
  • Kounadi, Theodora1
  • 1 Unit of Endocrinology and Diabetes Center, General Hospital of Athens 'G. Gennimatas', Athens, Greece. , (Greece)
  • 2 Laboratory for Research of the Musculoskeletal System "Th. Garofalidis", Medical School, National and Kapodistrian University of Athens, KAT Hospital, Athens, Greece. , (Greece)
  • 3 Department of Radiology, General Hospital of Athens 'G Gennimatas', Athens, Greece. , (Greece)
Type
Published Article
Journal
Journal of musculoskeletal & neuronal interactions
Publication Date
Jun 01, 2020
Volume
20
Issue
2
Pages
291–296
Identifiers
PMID: 32481245
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Vitamin D (vitD) deficiency and bone loss may occur after bariatric surgery and hence, supplementation with high oral doses of vitD may be required. Alternatively, intramuscular depot ergocalciferol, which slowly releases vitD and bypasses the gastrointestinal tract, could be administrated. We present a case of severe vitD deficiency-osteomalacia after gastric bypass operation for morbid obesity, treated with ergocalciferol intramuscularly. A 45-year-old woman was presented with hip pain and muscle weakness, which led ultimately to immobilization in a wheelchair. Fifteen years ago, she underwent roux-en-Y gastric by-pass for morbid obesity. Occasionally, she was treated with multivitamin supplements. On admission, iron deficiency anaemia, vitD deficiency (25OHD: 3.7 ng/ml) and secondary hyperparathyroidism were revealed. Bone turnover markers (BTM) were elevated. Radiological evaluation demonstrated insufficiency fractures on the pubic and left femur and reduced BMD. Osteomalacia due to vitD deficiency and calcium malabsorption were diagnosed. Calcium citrate 500 mg qid and intramuscular ergocalciferol 600,000 IU every 20 days were initiated. One month later, musculoskeletal pain and weakness were resolved and the patient was mobilized. Few months later, vitD, BTM and BMD showed substantial improvement. Intramuscular ergocalciferol administration can improve the clinical and biochemical status and thus, is suggested to prevent and/or treat osteomalacia in such patients.

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