I think the underlying consition is osteomalacia-- vitamin D deficiency. This causes defective mineralization of bones. Bones become soft & fracture easily. This might account for the wrist fracture. (Alternately osteoporosis due to old age might also explain for the fracture). The soft bones become painful with weight bearing.
Vitamin D3 levels greater than 30 are considered necessary for the prevention of osteomalacic fractures.So, levels of Vitamin D3 level of 26 are low & make you susceptible to fractures with trivial trauma.
Serum calcium level is fine.
Alkaline phosphatase levels are indicators of bone formation. In osteomalacia there is increased metabolic activity in bones, but there is defective mineralization of newly formed bones.This increase activity is seen as raised alkaline phosphatase values. Your alakaine phosphatase is marginally raised. Fall in alkaline phosphatase levels is considered as a clinical indicator of recovery.
TSH level of 1.917 mU/L is within normal limits.Your ESR & CK values are also normal.
The platelet level of just 260 is very low & can predispose you to spontaneous bleeding in internal organs. I would suggest consulting a physician for this particular problem & getting treatment.
Now coming to the reative lack of response of your osteomalcia to vitamin D therapy. Osteomalacia can be caused by, (besides vitamin D deficiency) low levels of phosphates in blood which can be caused by kidney problems like renal tubular acidosis, Fanconi syndrome & some familial syndromes of hypophosphatemia & certain cancers. These causes may not show an adequate response to vitamin D. These other causes of osteomalacia need to be investigated.
For the problem of osteomalacia, I would suggest consulting an orthopedic surgeon primarily . You may also have to consult an endocrinologist.
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