FRED question. Help!

[Northerncardinal]

A 57 year old man comes to ER due to cramping in his hands and feet and numbness and tingling around his lips and in his fingers; these symptoms occurred intermittently for 6 months but have been progressively severe during the past 2 weeks. He also has had a 13 kg wt loss and bulky, foul smelling stools that do not flush easily. He has a 10 year history of drinking 8 to 10 beers daily. He has been hospitalized twice for severe abdo pain 4 and 6 years ago. His pulse is 80/min, and BP is 105/65. He appears cachectic and chronically I'll. The abdomen is nontender. Deep tendon reflexes are 4+ bilaterally. Chvostek and trosseau signs are present. His serum calcium concentration is 6.5 mg/dl. What's the most likely diagnosis?
A. Hypomagnesemia
B. Hypoparathyroidism
C. Osteomalacia
D. Vitamin D deficiency

How to differentiate betweenC and D?

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[Reperfused]

Is the answer D?

He’s an alcoholic. Foul smelling, bulky stools point towards pancreatic insufficiency. Weight loss. I’m guessing this is pancreatic carcinoma. In any case, vitamin D is a fat soluble vitamin. If he has pancreatic insufficiency, that must be causing vitamin D deficiency. This is the reason he’s getting all the signs and symptoms of hypocalcemia because vitamin D facilitates absorption of calcium in the gut.

Let me know if my theory is right.

 

[Northerncardinal]

Is the answer D?

He’s an alcoholic. Foul smelling, bulky stools point towards pancreatic insufficiency. Weight loss. I’m guessing this is pancreatic carcinoma. In any case, vitamin D is a fat soluble vitamin. If he has pancreatic insufficiency, that must be causing vitamin D deficiency. This is the reason he’s getting all the signs and symptoms of hypocalcemia because vitamin D facilitates absorption of calcium in the gut.

Let me know if my theory is right.

Yes ans is D. Thx for breaking it down. I was considering osteomalacia equivalent to vitamin D deficiency so got confused.

 

[Reperfused]

Osteomalacia can be caused by vitamin D deficiency, yes.

But I think the reason why in this particular qs, osteomalacia wouldn’t be the most likely diagnosis is because it’s a disease of bones and this guy doesn’t have any bone related symptoms.