Case history
Case history
A 72-year-old man is evaluated for increasing fatigue and bone pain. His medical history is significant for chronic alcoholism, lactose intolerance, and a vertebral compression fracture 1 year ago. He is housebound without any sunlight exposure. He denies any personal or family history of kidney stones, fractures, or osteoporosis. His physical exam is remarkable for generalized tenderness of the long bones and proximal muscle weakness, with difficulty climbing stairs and a waddling gait.
Other presentations
Renal osteodystrophy (currently known as chronic kidney disease-mineral bone disorder [CKD-MBD]) manifests in patients with advanced renal failure with symptoms of vague bone pain localized to the lower back, hips, or legs. This condition may be so severe as to leave the patient bedridden. Osteomalacia is prevalent in patients on anticonvulsant therapy who have limited exposure to sunlight, such as institutionalized or disabled individuals. Milkman syndrome is a medical condition characterized by multiple insufficiency fractures that are often bilateral and symmetric. Typical fracture sites include the concave surfaces of the femoral neck, the axillary margin of the scapula, the pubic rami, and the ribs.
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