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PubMed1998

A potential risk for osteomalacia due to sociocultural lifestyle in Turkish women.

Osteomalacia is a metabolic bone disease caused by deficiency of vitamin D or its active metabolites. Because poor sunlight exposure is one of the most common causes of osteomalacia, the disease seems to be rare in countries with adequate sunlight. We report nine Turkish female patients with osteomalacia with ages between 21 and 50 years. Osteomalacia was diagnosed on the basis of a history of bone aches or pains, muscle weakness, low or low normal serum calcium and urinary calcium, decreased concentrations of serum inorganic phosphorus and 25- hydroxyvitamin D and increased serum intact PTH and alkaline phosphatase levels. Radiographically, pseudo-fractures were present in seven of the patients. The patients' symptoms and signs were relieved with the treatment with vitamin D analogues and calcium. Their hypovitaminosis D are suggested to be caused by excessive clothing in the outdoors due to sociocultural and religious reasons. Excessive clothing may be a risk factor for osteomalacia in young to middle-aged and otherwise healthy women even in countries with adequate sunlight.

Adult↗
PubMed2001

Diagnosis of a patient with oncogenic osteomalacia using a phosphate uptake bioassay of serum and magnetic resonance imaging.

A previously healthy man with no family history of fractures presented with muscle pain, back pain and height loss. Investigations revealed hypophosphataemia, phosphaturia, undetectable serum 1,25-dihydroxyvitamin D and severe osteomalacia on bone biopsy, suggestive of a diagnosis of oncogenic osteomalacia. Thorough physical examination did not locate a tumour. Support for the diagnosis was obtained by detection of phosphate uptake inhibitory activity in a blinded sample of the patient's serum using a renal cell bioassay. On the basis of detection of this bioactivity, a total body magnetic resonance (MR) examination was performed. A small tumour was located in the right leg. Removal of the tumour resulted in the rapid reversal of symptoms and the abnormal biochemistry typical of oncogenic osteomalacia. Inhibitory activity was also demonstrated using the bioassay in serum from two other patients with confirmed or presumptive oncogenic osteomalacia, but not in serum from two patients with hypophosphataemia of other origin. This is the first case to be reported in which the diagnosis of oncogenic osteomalacia was assisted by demonstration of inhibitory activity of the patient's serum in a renal cell phosphate bioassay that provided an impetus for total body MR imaging.

Adult↗
PubMed1978

Osteomalacia: current concepts.

Recently acquired knowledge about vitamin D metabolism has improved our understanding in different varieties of osteomalacia. Many new causes of osteomalacia continue to be found. Radiologic and biochemical changes are not always characteristic and may occasionally be misleading. Bone biopsy after a double tetracycline label is helpful in differentiating osteomalacia from high bone turnover conditions and is recommended in most patients with a generalized rarefying skeletal disorder. Even if the underlying disease state cannot be corrected, effective therapy is available in most varieties of osteomalacia. The newer metabolites of vitamin D should soon be generally available to the medical profession. Their use will make treatment of osteomalacia more individualized and specific.

Bone Development↗
PubMed2000

[Hypophosphatemic oncogenic osteomalacia].

The first case of oncogen osteomalacia in Hungary is reported, to draw the attention of the medical profession to it and to present the new data about its pathomechanism. Pathological hip fracture caused by hypophosphataemic osteomalacia due to isolated renal phosphate wasting was found in a previously healthy 19 years old sportsman. In spite of daily 1.5 micrograms calcitriol treatment and phosphate supplementation, hypophosphataemia persisted for 13 years and he needed regular indometacin medication for his bone pain. During that time an 1.5 cm gingival tumour was found and radically removed. The serum phosphate level returned to normal in a few hours after the operation (preoperative 0.51, after 2, 4 and 8 hours 0.61, 0.68 and 0.79 mmol/l respectively), and remained normal without calcitriol. The histological examination showed epulis with fibroblast and vascular cell proliferation, which has never been previously reported in connection with oncogenic osteomalacia. The pain resolved after 3 months and the bone density became normal in one year. Oncogenic osteomalacia must be considered in every case presenting with atypical hypophosphataemic osteomalacia. Careful dental examination is needed also in the course of search for the underlying tumour. Every tumour-like growth, even the common epulis, has to be operated radically and serum phosphate monitored in the postoperative period in all such cases.

Adult↗
PubMed1975

Osteomalacia associated with anticonvulsant drug therapy in mentally retarded children.

A survey of 289 severely retarded inpatients at a school for retarded children in American Fork; Utah revealed 67 patients with osteomalacia as defined by hypocalcemia, hypophosphatemia, elevated serum alkaline phosphatase levels, and appropriate bone changes. Investigation of the variables which might influence bone mineralization revealed no differences in age, sex, physical activity, sunshine exposure, or dietary intake of vitamin D between the osteomalacia and nonosteomalacia groups. However, all of the patients with osteomalacia were receiving anticonvulsant medications, either phenobarbital, diphenylhydantoin, or both. Duration of anticonvulsant therapy was the most important contributing factor to the development of osteomalacia. Seventy-five percent of patients who had received anticonvulsants for more than ten years had osteomalacia. The single most costly medical problem at the school is the treatment of pathologic bone fractures due to demineralized bone.

Adolescent↗
PubMedDate not supplied

Aetiology and clinical profile of osteomalacia in adolescent girls in northern India.

BACKGROUND: The adolescent age group is particularly prone to nutritional rickets/osteomalacia due to an increased demand for nutrients, especially calcium and vitamin D. Osteomalacia presents with non-specific signs and symptoms because of which diagnosis may be delayed. Vitamin D deficiency is unexpected in India, which is a tropical country with abundant sunshine. METHODS: We prospectively studied the clinical presentation, aetiology and social factors contributing to adolescent rickets/ osteomalacia in our region. RESULTS: We saw 21 symptomatic adolescents with osteomalacia during the study period (November 2000-July 2002). All were girls. Only 1 practised purda and 4 belonged to a low socioeconomic class. The mean (SD) duration of illness before correct diagnosis was 2.8 (2.1) years. Bone pains and muscular weakness were universally present. Non-specific complaints (especially limb pains being mistaken for joint involvement) led to a delay in diagnosis with consequent morbidity. All but 1 patient had low serum 25-hydroxyvitamin D levels (<10 ng/ml), with the mean (SD) being 4.9 (2.7) ng/ml. Their mean dietary calcium intake was low 1265 (199) mg/day, range 40-810 mg/day]. Restricted outdoor activities (n = 19) and the traditional dress code (n = 21) were contributory factors, as they led to poor exposure to sunshine. CONCLUSIONS: Nutritional osteomalacia among adolescents is a poorly recognized entity. Even in non-purda practising communities in the tropics, poor exposure to sunshine due to social factors, compounded by low dietary calcium intake, can lead to osteomalacia in adolescents.

Adolescent↗
PubMedDate not supplied

Presentation of osteomalacia in Kohistani women.

BACKGROUND: Osteomalacia is a common diagnosis in the Kohistani women presenting with aches and pains. This study was conducted to assess calcium and Phosphate levels in Kohistani women with osteomalacia. METHODS: 50 diagnosed cases of Osteomalacia selected from amongst the women presenting with body aches were included in the study. History regarding age, marital status, parity, dietary habits, socioeconomic status etc was taken. RESULTS: The median age was 23 years. 74% were married. Most of the women had 5 children (mode). Nine (18%) patients had hypocalcaemia, 10 (20%) had hypophosphatemia. Alkaline phosphatase was elevated in 13 patients (26%). Six (12%) patients were pregnant at the time. 74% of patients belonged to the poor class. 70% of the patients drank less than 1 cup of milk per day. Body aches (100%), waddling gait (14%), proximal myopathy (12%), bone tenderness (6%) and carpopedal spasm (8%). CONCLUSIONS: We therefore conclude that in comparison with other parts of the world where individual risk factors cause osteomalacia. Kohistani population has a higher frequency of osteomalacia due to aggregation of three major factors namely lack of sunlight due to geographical location, excessive clothing blocking available sunlight and nutritional deficiency.

Adult↗
PubMed1985

[Tumoral hypophosphoremic osteomalacia].

Various tumoral diseases may induce hypophosphataemic osteomalacia. This is the case, in particular, with mesenchymal tumours and sclerosing metastases of prostatic cancer; much less common causes are diffuse connective tissue dysplasias and non-prostatic epitheliomas. Depending on whether osteomalacia results from a mesenchymal tumour or from osteitis of prostatic origin, the practical problems encountered are quite different. In the first case, the important point is not to miss a mesenchymal tumour when confronted with an acquired and apparently idiopathic hypophosphataemia; repeated examinations at regular intervals are sometimes necessary to detect the tumour which is usually benign; osteomalacia can then be cured by its removal. In the second case, the difficulty is to detect an osteomalacia which may be masked by bone metastases and to recognize its tubular origin in order to prescribe the appropriate treatment. Little is known about the pathogenesis of tumoral hypophosphataemic osteomalacia. The renal diabetes and low 1,25 (OH)2 D plasma levels frequently associated with the disease reflect a complex enzymatic disorder thought to be caused by a humoral mediator secreted by the tumour. Studies carried out in this field have already shown that 1,25 (OH)2 D is therapeutically useful when the tumour cannot be excised.

Bone Diseases↗
PubMed1988

[Biologico-mechanical behavior of bone in osteomalacia and in phosphate diabetes in adulthood].

The main orthopedic complications in osteomalacia, skeletal deformities, Looser's transformation zones and fractures, are described. The limited value of a Looser's transformation zone as a radiographic diagnostic criterion for osteomalacia is mentioned, because such zones can also occur in other bone diseases with abnormal remodeling. This paper also outlines the differential diagnosis of a Looser zone against a stress fracture. In osteomalacia and phosphate diabetes the biological and mechanical properties of bone are different. In adult phosphate diabetes radiological examination is more likely to reveal osteosclerosis than a radio-opaque bone. For this reason we investigated the bone healing process in five adult patients with osteomalacia and in six with phosphate diabetes. In spite of the small number of patients we may assume that bone healing after surgery is delayed in phosphate diabetes compared with osteomalacia, in which a normal bone healing tendency is present.

Adult↗
PubMed1985

Aluminium-induced osteomalacia in severe chronic renal failure (SCRF).

In patients with severe chronic renal failure (SCRF), especially in those undergoing chronic dialysis, aluminium may accumulate in the body. The aluminium is derived from the dialysate and/or from orally-administered, aluminium-containing phosphate binders. Accumulation preferentially occurs in the bone causing aluminium-induced osteomalacia. The physiopathological mechanisms of the disease still have to be elucidated. It has been suggested that aluminium accumulates at the osteoid/calcified-bone boundary (OCBB) inhibiting the influx of calcium there, and also that aluminium directly suppresses the secretion of parathyroid hormone (PTH). A third factor inducing the mineralization defect may be the presence of aluminium within the mitochondria of the osteoblast. In accordance with these hypotheses, hypercalcemia and relatively low iPTH levels are frequently found in aluminium-induced osteomalacia. Histologic methods are essential for demonstrating the actual existence of aluminium-induced osteomalacia. A large bone biopsy is desirable. When the biopsy is not decalcified and embedded in plastic, excellent histologic pictures are obtained wherein mineralized and non-mineralized bone (i.e. osteoid) can be distinguished clearly. Furthermore, the un-decalcified sections can be stained for aluminium, iron or both, and they are suitable for evaluation of the bone marrow status. Several features, like irregularly distributed osteoid with variable thickness, a relatively low number of cubic osteoblasts, and the absence of marrow fibrosis, are suggestive of aluminium-induced osteomalacia. However, the latter can only be proven by histochemical methods, e.g. by the aluminon staining. The treatment of aluminium-induced osteomalacia is quite different from that of other types of renal bone disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Aluminum↗
PubMed1979

[Sacroiliac changes, HLA-B27 negative, in primary hyperparathyroidism and osteomalacia].

Radiological sacroiliac (SI) changes were found in 3 patients, 2 with primary hyperparathyroidism (1 also with associated chondrocalcinosis) and 1 with osteomalacia. Osteomalacia was due to celiac disease. None of the 3 patients, all females, had a history of psoriasis, urethritis, iritis or chronic colitis. There was no renal function impairment. Peripheral joints were affected in the patient with associated condrocalcinosis. HLA B 27 was negative in all cases. Low back pain and vertebral stiffness were present in the patient with osteomalacia. A dramatic improvement in pain and stiffness ensued after vitamin D injections. These SI lesions, which may simulate ankylosing spondylitis, were attributable to subchondral bone changes related to the metabolic bone diseases. In the case of osteomalacia the SI lesions were predominantly on the right side, where there was a Looser's zone on the ischial ramus suggesting that pseudofractures could be a cause of SI changes. Metabolic osseous diseases such as osteomalacia or primary hyperparathyroidism should be investigated in cases of HLA B 27 negative radiological "sacroiliitis".

Aged↗
PubMed1971

Rickets and osteomalacia of various origins.

Further causes of rickets or osteomalacia need to be added to the list previously published by the author. These include phosphate deficiency osteomalacia from prolonged consumption of aluminum hydroxide, rickets and osteomalacia from prolonged therapy by antiepileptic drugs, rickets associated with the severe form of osteopetrosis, further rare causes of the Fanconi syndrome, congenital rickets occurring when the mother has osteomalacia from dietary causes or has celiac disease and temporary neonatal rickets probably due to enzymic immaturity. The importance is stressed of defining as closely as possible the type of rickets or osteomalacia one is dealing with, especially when considering therapy and detailed pathogenesis.

Acidosis, Renal Tubular↗
PubMed1983

Symptomatic osteomalacia after jejunoileal bypass surgery in a patient with primary hyperparathyroidism. A study of the change in bone morphology and vitamin D metabolites before and during treatment.

A 48-year-old woman underwent jejunoileal bypass surgery for obesity while hypercalcemic. Three years later, she developed symptomatic osteomalacia impairing her daily activities. Bone biopsy confirmed the clinical diagnosis of osteomalacia, and treatment with 8000 U daily of vitamin D and milk resulted in striking improvement of clinical symptoms and resolution of her osteomalacia both chemically and histologically. The patient, however, again became hypercalcemic and a parathyroid adenoma was subsequently removed with restoration of serum calcium values to normal. Neither the occurrence and successful treatment of gross symptomatic osteomalacia consequent to jejunoileal bypass surgery, nor the obscuration of primary hyperparathyroidism by osteomalacia has been hitherto well documented in the United States.

25-Hydroxyvitamin D 2↗
PubMed1983

Osteomalacia in chronic renal failure before dialysis.

Bone biopsies taken from 327 patients before the start of dialysis have been correlated with clinical and biochemical findings to test various theories about the aetiology of osteomalacia. Two groups of patients, 100 with osteomalacia and 100 with pure osteitis fibrosa, have been compared in detail. Osteomalacia is associated with chronic pyelonephritis or obstruction as primary renal disease, and with acidosis, hypocalcaemia and normophosphataemia (as opposed to hyperphosphataemia). We have found no association between osteomalacia and known duration or severity of uraemia and in a small series of observations we have not confirmed previous reports of a close association between osteomalacia and depressed plasma 25(OH) cholecalciferol values.

Acidosis↗
PubMed1994

Osteomalacia--fifty five patients seen in a teaching institution over a 4 year period.

A retrospective analysis of 55 cases of osteomalacia shows that poor calcium intake and poor sunlight exposure are the most common causes for osteomalacia. However, in patients with normal nutritional history, other disorders such as renal tubular acidosis and tumour induced osteomalacia should be looked for. A careful drug history, particularly anticonvulsant use is essential. In 4 patients there was an association between anti-tuberculous drug use and osteomalacia. Further prospective studies are needed to determine the relationship between Rifamicin use and osteomalacia.

Adult↗
PubMed1996

[Osteomalacia cured by resection of cutaneous neurinoma].

INTRODUCTION: Regression of osteomalacia after exeresis of a skin tumor is unusual. CASE REPORT: A 62-year-old man had suffered from bone and joint symptoms for several years due to osteomalacia which was confirmed both biologically and histologically. The patient also had a plantar neurinoma. After exeresis of the tumor the biological results returned to normal levels within one week followed by regression of the clinical signs of osteomalacia. DISCUSSION: The neurinoma in this patient was apparently the cause of osteomalacia, since signs of the disease disappeared after exeresis. To date, three cases of neurinoma associated with osteomalacia have been published, including a single case with skin localization. The tumor would secrete a substance which inhibits the synthesis of vitamin D and enhances phosphorus excretion.

Foot Dermatoses↗
PubMed1983

Histomorphometric analysis of sclerotic bone metastases from prostatic carcinoma special reference to osteomalacia.

Transiliac undecalcified bone biopsy specimens were taken after tetracycline double labeling from 14 patients with radiologic evidence of osteosclerotic metastases from prostatic carcinoma. The histomorphometric analysis showed an increased trabecular bone volume in all patients, and in seven morphologic and dynamic evidence of osteomalacia (Group 1). The seven other patients demonstrated an extension of apposition surfaces without evidence of osteomalacia (Group 2). Group 1 was different from Group 2 in terms of a greater increase in serum alkaline phosphatase and a lower urinary calcium. In four Group 1 patients, a second bone sample taken after two to six months of treatment with vitamin D and calcium provided evidence of improving osteomalacia. The high incidence of osteomalacia in osteosclerotic metastases of prostatic origin appears to be the result of the increase in bone formation induced by prostatic cells, and the unability to satisfy the high calcium demand for new bone.

Aged↗
PubMed1997

Zinc and copper levels in ribs of cadmium-exposed persons with special reference to osteomalacia.

Cadmium (Cd), zinc (Zn), copper (Cu), calcium (Ca), phosphorus (P), and magnesium (Mg) were determined in ribs obtained at autopsy from 38 Cd-exposed and 17 nonexposed subjects to determine how levels of these elements in bone are affected by Cd exposure and whether they are associated with the bone lesions due to Cd exposure, osteomalacia, and osteoporosis. Cd in ribs was significantly higher in the Cd-exposed subjects than in nonexposed subjects. Zn tended to be higher, while Cu, Ca, P, and Mg tended to be lower in the ribs of Cd-exposed subjects, though these differences were not statistically significant. Zn, Ca, P, and Mg were highly correlated with each other in both Cd-exposed and nonexposed groups, but the associations of Ca, P, and Mg in the ribs with Zn concentrations differed in subjects and controls. Ca to Zn ratios were low in the Cd-exposed subjects, and the higher the grade of osteomalacia, the lower the Ca/Zn ratio. The decrease in Ca/Zn ratio was significantly correlated with increases in Cd. Cu showed a significant positive correlation with Cd and significant inverse correlation with Ca, P, and Mg in the Cd-exposed group. Cu and its relation to other elements did not show any association with osteomalacia. In conclusion, Ca/Zn ratio in bone was related to Cd exposure and the degree of osteomalacia in the Cd-exposed subjects.

Aged↗