Vitamin D and Health

Table 7: Case reports of osteomalacia
Study/Country Population Osteomalacia diagnosis Mean serum 25(OH)D (nmol/L) &
Ca (mg/L) concentrations
Clark et al (1972)
Newcastle upon Tyne,
UK
Patients: n=15; age 11-42y. South Asian, living in the UK ≥ 1y
(mean 4.5 y).
Presented with spontaneous pain, usually in legs, 4 seen
following minor injury
Blood relatives: n=18, age 8-48 y; 3 with symptoms of limb pain.
Biochemical evidence of rickets and osteomalacia.
12/15 patients and 2/18 relatives had radiological
evidence.
2/3 patients histological evidence.
25(OH)D: not reported
Ca
Patients: 84
Blood relatives: 92
Moncrieff & Fadahunsi
(1974)
Derby, UK
Female (pregnant); age 30 y. South Asian ethnic origin.
Presented with pain in sacrum & waddling gait during latter part
of pregnancy
Biochemical and clinical evidence of osteomalacia; x-ray
of pelvis did not show osteomalacia.
Mother (after delivery)
25(OH)D: 17.7/Ca: 82
Russell & Hill (1974)
Manchester, UK
De Torrente de la Jara et
al (2004)
Switzerland
Cardinal & Gregory
(2009)
Cambridge, UK
Thabit et al (2011)
Ireland
Mittal et al (2012)
India
Female (pregnant) - age 30 y; South Asian ethnic origin
Presented with signs of pre-eclampsia at 37 weeks gestation
(not treated)
Infant - male, delivered spontaneously
Female asylum seekers (n=11) from Bosnia, Afghanistan,
Somalia, Albania, Ethiopia
Presented with minimal exposure to sunlight & history of bone
pain, proximal muscular weakness, change in gait, or fatigue.
Female, age 75 y. White
Schizophrenic, inpatient in psychiatric hospital for > 35 years;
investigated due to persistent elevated alkaline phosphatase &
intermittently low phosphate and calcium concentrations.
Case 1: Male, age 31 y. S Asian ethnic origin, living in Ireland
(5y). 2 day history of upper & lower limb tetany; unable to stand
unaided due to progression of bilateral lower limb weakness.
Case 2: Female, age 34 y. S Asian ethnic origin, living in Ireland (9
y). Pains pelvic region for 4y; proximal muscle weakness &
difficulty walking, significant proximal myopathy & waddling
gait.
Male, age 41 y.
Presented with gradually progressive quadriparesis over
previous 6 m.
No clinical evidence of osteomalacia at 37 weeks
gestation; x-ray confirmed fetal rickets.
4 months after delivery: biochemical evidence of
osteomalacia but x-ray normal
Infant – wrist x-ray confirmed rickets.
At 37 weeks gestation:
25(OH)D : 7.5/Ca: 72
4 months after delivery:
25(OH)D: 6.7/Ca: 76
Measurement of 25(OH)D concentration. 25(OH)D: 10.9 (3.8)
Ca: 87.6 (3.6)
Biochemical evidence of osteomalacia 25(OH)D: 10.5
Biochemical evidence. Case 1
25(OH)D: 5.5/Ca: 57.2
Case 2
25(OH)D: 16/Ca: 81.6
Based on symptoms. 25(OH)D: 20.3
Ca: 81.2
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