Vitamin D Deficiency Osteomalacia Related to Hypophosphatemia in a Patient with Anorexia Nervosa : A Case Report

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  • Nakamura Takuya
    Department of Psychosomatic Medicine, National Center for Global Health and Medicine Kohnodai Hospital
  • Fujimoto Koji
    Department of Psychosomatic Medicine, National Center for Global Health and Medicine Kohnodai Hospital Department of Psychosomatic Medicine, Kyushu University Hospital
  • Tatsushima Keita
    Department of Endocrinology and Metabolism, Toranomon Hospital
  • Tsuji Hiromi
    Department of Psychosomatic Medicine, National Center for Global Health and Medicine Kohnodai Hospital
  • Tamura Naho
    Department of Psychosomatic Medicine, National Center for Global Health and Medicine Kohnodai Hospital
  • Kawai Keisuke
    Department of Psychosomatic Medicine, National Center for Global Health and Medicine Kohnodai Hospital

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Other Title
  • 低リン血症を契機にビタミンD欠乏性骨軟化症の診断に至った神経性やせ症の1例
  • テイリン ケッショウ オ ケイキ ニ ビタミン D ケツボウセイ ホネ ナンカショウ ノ シンダン ニ イタッタ シンケイセイヤセ ショウ ノ 1レイ

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<p>Introduction : Although osteoporosis is a well-known complication of anorexia nervosa (AN), osteomalacia is presented in a few reports. We herein describe a case of vitamin D deficiency osteomalacia related to hypophosphatemia in a patient with AN.</p><p>Case report : A woman in her 50s had a history of weight loss, with her body mass index (BMI) at one time decreasing to 10 kg/m2. She was diagnosed with AN and underwent treatment as an outpatient. She began to withdraw from society and isolated herself at home. Her serum phosphorus level decreased to 0.5 mg/dl, and she was admitted to our department on an emergency basis. She was diagnosed with vitamin D deficiency osteomalacia related to hypophosphatemia. She had high bone ALP level (bone specific alkaline phosphatase〔BAP〕, 29.5 µg/l), decreased bone density (lumbar spine young adult mean〔YAM〕, 47%), increased bone scintigraphic uptake (ribs and spine), vitamin D deficiency (25 [OH] D, 5.2 ng/ml), normal fibroblast growth factor 23 (FGF 23) level (15.0 ng/ml), and normal urine. After regaining weight through nutritional therapy, supplemental vitamin D therapy, and sunbathing, the serum phosphorus and ALP levels normalized ; subsequently, she was discharged from the hospital.</p><p>Discussion : We speculate that the patient’s long-term low nutritional status and home isolation caused vitamin D deficiency osteomalacia. No serious symptoms developed because the hypophosphatemia allowed the diagnosis of the disease at an early stage. Because patients with AN are at high risk for vitamin D deficiency, the risk of osteomalacia as well as osteoporosis, should be considered.</p>

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