Osteomalacia in a hemodialysis patient receiving an active vitamin D sterol

Background A 17-year-old Filipino male hemodialysis patient presented for renal transplant evaluation. He had significant skeletal abnormalities characterized by bone pain, an inability to walk, and secondary hyperparathyroidism despite therapy with an active vitamin D sterol (paricalcitol). Investigations The patient underwent a physical examination, and his serum levels of calcium, phosphorus, alkaline phosphatase, parathyroid hormone, aluminum and 25-hydroxycholecalciferol (25OH-vitamin D) were determined. X-rays of hips and lower extremities, MRI, and bone histomorphometry after double tetracycline labeling were performed. Diagnosis Osteomalacia associated with low 25OH-vitamin D levels. Management Monthly therapy with ergocalciferol (vitamin D-2) and discontinuation of paricalcitol.