Abstract
Objective. We present the clinical, biochemical, and imaging findings of a woman with vitamin D deficiency and severe osteomalacia related to intravenous heroin addiction. Results. A 54-year-old woman with a medical history significant for long-standing heroin abuse presented with complaints of bone pain, muscle cramping, and a left hip ulcer. She had been bed bound for approximately 1 year secondary to pain of uncertain etiology, and her husband was bringing her both food and drugs. She was admitted to the hospital for debridement of a right ischial ulcer. Further workup revealed osteomyelitis of the left hip and severe vitamin D deficiency. Radiologic evaluation demonstrated diffuse osteopenia with pseudofractures, as well as true fractures. Conclusion. This is the first case reported in the English literature of advanced osteomalacia resulting from a debilitating narcotic dependency. Vitamin D deficiency should be considered in patients with poor nutrition and prolonged sunlight deprivation from any cause.
Highlights
IntroductionA deficiency of vitamin D disturbs calcium homeostasis and causes a secondary hyperparathyroidism
Vitamin D is necessary to maintain bone integrity
It had been assumed that the public health effort to fortify foods with vitamin D had eliminated vitamin D deficiency as a serious health problem
Summary
A deficiency of vitamin D disturbs calcium homeostasis and causes a secondary hyperparathyroidism. A 54-year-old Hispanic woman presented to the emergency room with complaints of bone pain, muscle cramping and a left hip ulcer. Her past medical history was significant for 30 years of intravenous heroin abuse. She was frail and ill appearing, but not in acute distress She had contractures of the upper and lower extremities, as well as a 7 × 7 cm ulceration on the left ischium with serosanguinous drainage that she attributed to an old burn injury and that she admitted using for heroin injection. Estrogen levels were not determined, but gonadotropins were suppressed, with luteinizing hormone
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