Vol 39 # 2 June 2007 - Kma.org.kw

154The Influence of Insufficient Exposure to Sunlight on Vitamin D Deficiency and Related ... June 2007vitamin D deficiency in patients with osteomalaciathat was complicated with osteoporosis in some ofthem in a place with sunny climate (Kuwait) andassessed the clinical and biochemical effect of highdoses of vitamin D in the treatment of osteomalacia.SUBJECTS AND METHODSFrom July 2002 to June 2003, we recruited 24consecutive patients with osteomalacia. Patientswere referred to the metabolic bone disease clinic inAl-Jahra hospital, Kuwait, from orthopedic ormedical outpatient clinics for evaluation ofosteomalacia. They presented with symptoms ofbone pain, fatigue, proximal muscle weakness,biochemical findings and/or radiological imagessuggestive of osteomalacia. Other causes of ricketsand osteomalacia apart from vitamin D deficiencysuch as inadequate dietary ingestion or insufficientsunlight exposure were excluded by appropriateclinical and laboratory investigations. The clinicalparameters recorded were: age, sex, exposure tosunlight (exposure of the uncovered face and armsor lower legs to sun light at least 10 minutes daily),diet that contain at least 1 g of calcium per day, andsymptoms of generalized weakness, numbness,bone pain, and signs of proximal myopathy. Thebiochemical parameters recorded initially and aftertreatment with high dose vitamin D were: serumcalcium, phosphate, alkaline phosphatase, urinarycalcium and phosphate, PTH and 25(OH)D levels.The bone mineral density of the lumbar andfemoral sites was performed in most patients usinga DEXA scan. Osteopenia is defined according tothe WHO as T- Score = -1 and > -2.5 ando s t e o p o rosis as T- s c o re ≤ -2.5. Complete bloodcount, liver and renal profiles were performed in allpatients. Patients were treated with oral vitamin D(ergocalciferol) 600,000 U per week for two weeks,then every other week for two doses then oncemonthly for three months. They were also givenoral calcium 1.5 g per day in the form of calciumcarbonate or citrate. Symptoms of hypercalcemia ifany, such as lethargy, fatigue, confusion, nausea,vomiting, constipation, polyuria, polydipsia andabdominal pain were noted. Health education inthe value of sunlight exposure for at least 10minutes daily of the uncovered skin such as theface, arms and/or legs and consumption of at least1 g of calcium daily from dairy product, greenvegetables and/or fish consumption was given tothe patients verbally in the clinic. Exclusion criteriaincluded patients with liver, gastrointestinal orkidney disease and those on any medication thati n t e r f e res with vitamin D metabolism such asantiepileptic drugs.RESULTSAll the 24 patients diagnosed with osteomalaciaTable 1a: P re - t reatment biochemical values of patients withosteomalaciaPatient Calcium Phosphate Alkaline Urinary PTH25 (OH)DNo. (mmol/l) (mmol/l) phospha- Calcium phosphate (pmol/l) leveltase(mmol/l) (mmol/24hr) (nmol/l)1 2.24 0.9 738 0.87 9.6 32.4