Combined anticonvulsant osteomalacia and paget's disease: a case report

In a 71-year-old woman with severe anticonvulsant osteomalacia and Paget's disease, vitamin D (50,000 units orally twice/week and 400 units orally daily) produced dramatic subjective improvement. Bone biopsies showed a striking increase in areas of mineralized bone after treatment, although the pagetoid appearance of bone trabeculae remained unchanged. The patient's blood and urinary calcium levels were low initially, and did not increase significantly after vitamin D administration. When Paget's disease is associated with anticonvulsant osteomalacia, moderately high doses of vitamin D may safely reverse the course of the osteomalacia and induce remineralization of the skeleton.