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DoogleNK, Doctor (MD)
Category: Health
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Experience:  MD
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i have had severe bone/joint pain for 4 years. At ...

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i have had severe bone/joint pain for 4 years. At present my Vitamin D is 26 , my calcium serum is 9.5, my platelets are half of what they were a year or 2 ago, and are now 260. ALkaline Phosphatase, S is 160(range is 25-150). I also have unacounted for fractures in my left wrist. My TSH is 1.917. SED rate is 20 WESTARGREN (RANGE IS 0 TO 20) cREATINE kINASE, tOTAL SERUM IS 25(RANGE IS 24-204) cAN YOU TELL ME WHAT THIS MEANS AND WHAT KIND OF M.D. I SHOULD SEE. tHANK YOU. mY EMAIL [email protected]
May I know if the vitamin D level is mentioned in ng/ml or nMol/L.
The values are different in different units.

Also do you mean your platelets are 260 only or is it 2.6 lacs?

Customer: replied 9 years ago.
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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Customer: replied 9 years ago.
I'm seeing a rhuematologist, nd she doe not answer as to what kinds of minerald, I should take, with the D. I am taking calcium, 1000 mg every day. What other minerals should I take, and how much? I am 5'4" and weigh 222. I lost 82 pounds, this year. Thank you, XXXXX XXXXX advice, I will see a orthopedic doctorand an endocrinologist. I will also see a docotor for a scope of my indtestines,and a pulmonary doctor because have hx of smokinng and asthna/ Would these all cover the types of cancers that I'm now worried about?
Just one correction that I would like to make to what the doctor has said... Your platelets at 250 are absolutely normal and there is nothing to worry about in terms of bleeding...

Kindest Regards
I would clarify about the platelet counts--
Normal platelet counts are 1.5 to 4.5 lacs per microleter (150000 to 450000 platelets per microlitre).
If your platelet counts are 260,000, then they are normal.
But if they really are (unusual situation) just 260 then they are very low & can predispose to spontaneous bleeding.
Please check the report again for what unit of platelet conut is mentioned there.
The tumors causing osteomalacia are lung cancer, bone cancer, multiple myeloma, giant cell tumor, fibrous dysplasia & many more. I think it is right to start with the doctors you are seeing- an orthopedic surgeon, endocrinologist & pulmonolgist.
I would suggest adding vitamin C to your diet or as a supplement in addition to vitamin D & calcium.
Kindly press ACCEPT if your question has been answered. FEEDBACK is always appreciated.
Please note that the information provided is not a substitute to medical advice.

DoogleNK, Doctor (MD)
Category: Health
Satisfied Customers: 1139
Experience: MD
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