A 67 year-old man is evaluated after being treated for a broken arm. He sustained a small hairline fracture of the distal ulna after hitting his arm on a railing. He says it was only a minor bump and is surprised it caused a fracture. Serum chemistry is remarkable for elevated calcium at 11.6, low phosphate at 2.1, and slightly elevated alkaline phosphatase at 98. What is the most likely diagnosis?
A. Hyperparathyroidism
B. Osteoporosis
C. Paget's disease of bone
D. Renal insufficiency
E. Vitamin D deficiency
A. Hyperparathyroidism
B. Osteoporosis
C. Paget's disease of bone
D. Renal insufficiency
E. Vitamin D deficiency