Low calcium+ low phosphate + high alk phosphatase = osteomalacia
Low calcium +low phosphate + high PTH = Osteomalacia vs pseudohypopararhroidism . Bone changes and s vit D will differentiate .
normal calcium +high phosphate + high PTH+ renal impairment =tertiary hyperparathyroidism
Normal calcium +normal phosphate+ high alkaline phosphatase = Paget,s disease
High calcium +low phosphate + high PTH = primary hyperparathyroidism .
Tertiary hyperparathyroidism = parathyroidectomy or cinacalcet if surgery unfeasible .
Osteomalacia with renal failure = Alpha calcidol .
Paget,s disease = biphsphanatss