After receiving a kidney transplant, some patients develop a serious bone condition called osteomalacia, which happens when bones don’t get enough vitamin D and become weak and painful. Doctors often miss this problem because they focus on other transplant complications. This case study follows a 61-year-old woman who developed severe bone pain and difficulty walking after her transplant. By treating her with high-dose vitamin D and other medications, doctors were able to reduce her pain and help her walk normally again within 9 months. The study reminds doctors to regularly check vitamin D levels and bone health in transplant patients to catch and treat this condition early.

The Quick Take

  • What they studied: Whether a kidney transplant patient with severe vitamin D deficiency and bone pain could recover with aggressive vitamin D treatment and other bone-supporting medications
  • Who participated: One 61-year-old woman who received a kidney transplant from a living donor in 2020 and developed severe bone problems four months later
  • Key finding: After 9 months of high-dose vitamin D treatment combined with other medications, the patient’s vitamin D levels normalized, her bone pain disappeared, she regained the ability to walk independently, and her bone density improved significantly
  • What it means for you: If you’ve had a kidney transplant and experience bone pain, weakness, or difficulty walking, ask your doctor to check your vitamin D levels. Early treatment with vitamin D and other medications may help prevent serious bone damage and restore your mobility, though results vary by individual.

The Research Details

This is a case report, which means doctors documented the medical history and treatment of one patient in detail. The 61-year-old woman had a kidney transplant and four months later developed widespread bone pain and walking problems. Doctors performed blood tests that showed very low vitamin D (7 ng/mL, when normal is above 30), low phosphate levels, and high parathyroid hormone levels. They also used imaging tests like X-rays and bone scans to confirm osteomalacia—a condition where bones don’t mineralize properly, making them weak and painful.

The doctors treated her with very high doses of vitamin D (60,000 IU daily) for several weeks, then switched to a monthly vitamin D injection called calcifediol. They also gave her cinacalcet (a medication to control parathyroid hormone) and later added a bisphosphonate (a medication that strengthens bones). The team tracked her progress over 26 months using blood tests and bone density scans.

Case reports are valuable because they document unusual or overlooked conditions in real patients, helping doctors recognize similar problems in other patients. However, they only show what happened in one person, so results may not apply to everyone.

Kidney transplant patients are at high risk for bone disease because their new kidney doesn’t work perfectly at first, their anti-rejection medications affect bone health, and their calcium and phosphate metabolism is disrupted. Osteomalacia is often missed because doctors focus on other transplant complications. This case report is important because it shows that aggressive vitamin D treatment can actually reverse bone damage and restore function, which wasn’t well-documented before. It also highlights that routine bone and mineral monitoring should be standard care for all transplant patients.

This is a single case report, which is the lowest level of scientific evidence. It shows what happened in one patient but cannot prove that the same treatment will work for everyone. The case is well-documented with multiple imaging tests and blood work, which strengthens the reliability of what was observed. However, we cannot know if the patient’s improvement was due to the treatment, natural healing, or other factors. The authors appropriately call for controlled studies to test whether this treatment works in larger groups of patients.

What the Results Show

The patient presented four months after kidney transplant with severe, widespread bone pain and progressive difficulty walking. Her blood tests revealed extremely low vitamin D (7 ng/mL), low phosphate (2.8 mg/dL), and elevated parathyroid hormone (130 pg/mL). Bone imaging showed characteristic signs of osteomalacia including bone marrow swelling in both knees and special patterns called Looser zones that indicate defective bone mineralization.

After starting high-dose vitamin D treatment (60,000 IU daily), the patient’s vitamin D level rose to 42 ng/mL within several months. Her bone pain improved significantly, and she regained the ability to walk independently by 9 months post-transplant. Blood markers of bone turnover decreased, indicating that her bones were healing.

At 26 months after transplant, follow-up bone density scans showed improvement in her lumbar spine (the lower back), with her bone density score improving from -3.7 to -2.6 on the T-score scale. Her hip bone density remained low but stable. These improvements suggest that the aggressive vitamin D and mineral treatment not only relieved her symptoms but also partially reversed the bone loss.

The case demonstrated that very high levels of bone-specific alkaline phosphatase (an enzyme released by bone cells) reflected both the defective bone mineralization and the high rate of bone turnover occurring in osteomalacia. The combination of cinacalcet (to control parathyroid hormone), vitamin D supplementation, and later bisphosphonate therapy worked together to normalize mineral metabolism. The patient’s recovery of independent ambulation within 9 months was particularly significant because it shows that functional improvement can occur relatively quickly with proper treatment.

Osteomalacia in kidney transplant patients has been recognized for decades but is frequently overlooked in modern transplant care. Previous research showed that vitamin D deficiency is common after transplantation, but few studies documented whether aggressive vitamin D treatment could reverse bone damage and restore function. This case adds to growing evidence that early recognition and intensive treatment of vitamin D deficiency in transplant patients may prevent long-term bone complications. The case also supports earlier findings that mineral metabolism monitoring should be routine in transplant care, not just an afterthought.

This is a single case report, so we cannot know if these results would occur in other patients. The patient’s improvement could be due to the treatment, natural healing over time, or a combination of factors. We don’t know if all transplant patients with osteomalacia would respond as well to this treatment regimen. The case doesn’t tell us the optimal doses of vitamin D or the best timing for treatment. Different patients may have different underlying causes for their vitamin D deficiency and bone disease, which could affect treatment response. The authors appropriately note that controlled studies comparing different treatment approaches are needed to establish best practices.

The Bottom Line

If you are a kidney transplant recipient, ask your doctor to regularly check your vitamin D levels, calcium, phosphate, and parathyroid hormone levels—ideally starting before transplant and continuing for at least the first year after. If you develop bone pain, muscle weakness, or difficulty walking after transplant, report this immediately to your transplant team and request vitamin D testing. If you are diagnosed with severe vitamin D deficiency, high-dose vitamin D supplementation (similar to what this patient received) appears to be effective, though your doctor should monitor your response with blood tests. These recommendations are based on this single case and expert opinion, not large-scale studies, so individual treatment should be personalized by your transplant team.

This information is most relevant to kidney transplant recipients, especially those in the first year after transplant when bone disease risk is highest. It’s also important for transplant doctors, nephrologists, and primary care physicians who care for transplant patients. People considering kidney transplant should be aware that bone health monitoring is part of post-transplant care. This case is less relevant to people with kidney disease who have not had a transplant, though they may also benefit from vitamin D monitoring.

In this case, vitamin D treatment began to show effects within weeks (vitamin D levels normalized within months), bone pain improved significantly by 3-4 months, and independent walking was restored by 9 months. Bone density improvements took longer, becoming apparent by 26 months. However, individual responses vary, and some patients may improve faster or slower. Don’t expect overnight results, but significant improvement in symptoms and function can occur within several months of starting treatment.

Want to Apply This Research?

  • Track your vitamin D levels (25-hydroxyvitamin D), phosphate, calcium, and parathyroid hormone levels every 3 months for the first year after kidney transplant, then every 6-12 months thereafter. Log the dates and values in your health app to share with your transplant team and identify trends.
  • Set a daily reminder to take your vitamin D supplement at the same time each day. If prescribed high-dose vitamin D, use the app to track doses and any side effects like nausea or constipation. Also log any new bone pain, muscle weakness, or difficulty walking so you can report these to your doctor promptly.
  • Create a long-term tracking dashboard that shows your vitamin D levels over time with a target range (typically above 30 ng/mL). Set quarterly reminders to schedule lab work. Track bone-related symptoms monthly, including pain location and severity (1-10 scale), mobility level, and any falls or fractures. Share this data with your transplant team at each visit to ensure your bone health is being actively managed.

This case report describes the experience of one patient and should not be considered medical advice for your individual situation. Osteomalacia and vitamin D deficiency after kidney transplant require personalized evaluation and treatment by your transplant team or nephrologist. If you are a kidney transplant recipient experiencing bone pain, weakness, or mobility problems, contact your doctor immediately rather than self-treating. The treatment described in this case (high-dose vitamin D and other medications) may not be appropriate for all patients and requires medical supervision due to potential side effects and interactions with other medications. Always consult with your healthcare provider before starting any new supplements or medications, especially if you have had a kidney transplant.