A young female with a 2 year history of abdominal pain who presented 4 months after a laparoscopic cholecystectomy with ongoing abdominal pain, amenorrhea, significant variations in her weight. She appeared bow legged and kyphotic on exam. She had severe metabolic derangements including an incredibly low calcium and vitamin D. Imaging demonstrated sacral fractures. Further history elicited that the patient had a very limited dietary intake.
*In patients presenting with secondary amenorrhea ALWAYS ask about diet. One of the most common causes of functional hypothalamic amenorrhea is eating diosrders. In this case, we failed to ask this question as a group!
*Osteomalacia is a disorder of decreased mineralization of newly formed osteoid at sites of bone turnover
-Mineralization abnormalities occur as a consequence of inadequate calcium, phosphate – or in the presence of abnormal bone matrix or direct inhibition of the mineralization process
-Several difference disorders cause osteomalacia: severe vitamin D deficiency secondary to inadequate dietary intake, lack of sun exposure, gastric bypass or malabsorption – vit D deficiency is the MOST common cause
Kaiser SF Internal Medicine Residency Blog 