This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Hypercalcemia and Hypocalcemia, Subject name: Medicine
A patient presents with decreased calcium, decreased phosphate and increased alkaline phosphatase. Diagnosis is - 
Select and explain. 
A. Hyperparathyroidism, B. Vitamin D deficiency, C. Osteoporosis, D. Chronic renal failure
B: Vitamin D deficiency
Answer: B: Vitamin D deficiency 
Explanation: Ans. is 'b' i.e., Vitamin D deficiency Changes in vitamin D deficiency (Osteomalacia or Rickets)o Serum Ca++-Normal to decreaseo Serum P04-Decreasedo Alkaline phosphatase -Increasedo PTH -N/increase Serum CaSerum phosohorusAlkaline PhosphatasePTHPrimary Hyperparathy roiriismIncreaseDecreaseIncreaseIncreaseSecondary' hyper parathyroidismDecrease or NIncreaseIncreaseIncreaseOsteoporosisNNNNPaget's diseaseNNIncreaseNOsteomalacia (Vitamin D deficiency)DecreaseIncrease/ decreaseIncreaseN/Increase