An endocrine evaluation is requested for a female patient aged who has been experiencing progressive, deep skeletal aching and difficulty rising from a seated position over the last half-year. Five years prior, the patient underwent bariatric surgery (Roux-en-Y bypass) to manage severe obesity, resulting in a weight loss of kg ( lb). She admits to poor adherence with her prescribed postoperative vitamin regimen. Physical examination demonstrates a distinct waddling gait and marked tenderness upon palpation of the sternum, ribs, and anterior tibia. Proximal muscle strength is symmetrically reduced in the bilateral lower extremities.
Initial laboratory investigations reveal the following results:
| Laboratory Parameter | Patient Value | Reference Range |
|---|---|---|
| Serum calcium | mg/dL | mg/dL |
| Serum phosphorus | mg/dL | mg/dL |
| Alkaline phosphatase | U/L | U/L |
| Intact parathyroid hormone | pg/mL | pg/mL |
| -hydroxyvitamin D | ng/mL | ng/mL |
Based on the patient's clinical presentation and laboratory findings, which of the following describes the most probable underlying histologic abnormality in this patient's skeletal system?
- AOverall reduction in trabecular bone mass with normal mineral-to-matrix ratio
- BHaphazard arrangement of woven and lamellar bone with cement lines
- Excessive accumulation of unmineralized osteoid matrixAnswer
- DSubperiosteal cortical thinning with cystic spaces filled with brown fibrous tissue
- EAccumulation of monoclonal plasma cells replacing normal hematopoietic elements