This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Orthopaedics
A patient Shweta with raised serum alkaline phosphatase and raised parathormone level along with low calcium and low phosphate level is likely to have - 
Select and explain. 
A. Primary hyperparathyroidism, B. Paget's disease, C. Osteoporosis, D. Vitamin D deficiency
D: Vitamin D deficiency
Answer: D: Vitamin D deficiency 
Explanation: Vitamin D deficiency will have : -

Low calcium
Low phosphate
High alkaline phosphatase
High parathormone level (secondary hyperparathyroidism)

About other options

In primary hyperparathyroidism : -


High calcium
Low phosphate
High alkaline phosphatase
High parathormone level


In osteoporosis all these parameters are normal.
In Paget's disease, calcium and phosphate levels are normal. Serum alkaline phosphatase is raised.