Vitamin D (vitD) deficiency and bone loss may occur after
bariatric surgery and hence, supplementation with high oral doses of vitD may be required. Alternatively, intramuscular depot
ergocalciferol, which slowly releases vitD and bypasses the gastrointestinal tract, could be administrated. We present a case of severe vitD deficiency-
osteomalacia after
gastric bypass operation for
morbid obesity, treated with
ergocalciferol intramuscularly. A 45-year-old woman was presented with hip
pain and
muscle weakness, which led ultimately to immobilization in a wheelchair. Fifteen years ago, she underwent roux-en-Y gastric by-pass for
morbid obesity. Occasionally, she was treated with multivitamin supplements. On admission,
iron deficiency anaemia, vitD deficiency (25OHD: 3.7 ng/ml) and
secondary hyperparathyroidism were revealed. Bone turnover markers (BTM) were elevated. Radiological evaluation demonstrated
insufficiency fractures on the pubic and left femur and reduced BMD.
Osteomalacia due to vitD deficiency and
calcium malabsorption were diagnosed.
Calcium citrate 500 mg qid and intramuscular
ergocalciferol 600,000 IU every 20 days were initiated. One month later,
musculoskeletal pain and weakness were resolved and the patient was mobilized. Few months later, vitD, BTM and BMD showed substantial improvement. Intramuscular
ergocalciferol administration can improve the clinical and biochemical status and thus, is suggested to prevent and/or treat
osteomalacia in such patients.