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Osteomalacia and Phenytoin Therapy
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
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•Type with double-spacing
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TO THE EDITOR:
In her review article [1], Dr. French mentions osteoporosis that is treatable with vitamin D as a long-term consequence of phenytoin therapy. In fact, osteomalacia with hypocalcemia and elevated alkaline phosphatase levels is far more common. This condition is attributed to both altered metabolism of vitamin D and the inhibition of intestinal absorption of Ca++[2]. Phenytoin also increases the metabolism of vitamin K and reduces the concentration of vitamin K-dependent proteins that are important for normal Ca++ metabolism [3]. This may explain why osteomalacia is not always ameliorated by the administration of vitamin D. Phenytoin may block the effect of the parathyroid hormone on bone, inducing a type of pseudohypoparathyroidism [4], with resulting bone and teeth changes.
Mumtaz A. Siddiqui, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
