Endocrine and Metaboliccommon
A 63-year-old woman reports several months of bone pain and difficulty climbing stairs. She has no focal neurological deficit. Serum calcium is 2.19 mmol/L (2.15–2.55), phosphate is 0.62 mmol/L (0.80–1.50), alkaline phosphatase is 310 U/L (30–110), and 25-hydroxyvitamin D is 18 nmol/L (greater than 50). Which diagnosis best explains these findings?