Abstract
This chapter exhibits the case of a man suffering from osteomalacia due to anticonvulsant therapy and vitamin D deficiency; malabsorption due to chronic pancreatitis with exocrine dysfunction. A 67-year-old farmer was admitted because of suspicion of osteomalacia. His medical history revealed epilepsy caused by cerebral trauma in 1947, an implanted dynamic hip screw for a right femur neck fracture in 1991 and a fracture of the left humerus in 1996. Despite an impressive daily regimen of carbamazepine, valproate, phenytoin, vigabatrin, and acetazolamide, the patient experienced repetitive absence seizures. Laboratory testing revealed reduced serum calcium and phosphate, high alkaline phosphatase, high parathyroid hormone, and low levels of 25-hydroxy vitamin D 3 and 1,25-dihydroxy vitamin D 3. Lumbar bone mineral density was 3.2 standard deviations below the mean value of a reference group of 30-year-old males. The patient was treated with high dosages of vitamin D, calcium and pancreatic enzymes. After 1 year this treatment resulted in complete disappearance of clinical symptoms, increased weight, increased lumbar bone density, and normalization of biochemical parameters. Anticonvulsant-related osteomalacia is an insidious disorder that may lead to considerable morbidity if not detected at an early stage. This case shows the need for monitoring vitamin D levels in patients using anticonvulsants.
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