Clinical presentation and etiology of osteomalacia/rickets in adolescents

Abstract

This study was conducted to determine the causes and clinical presentations of osteomalacia/rickets in adolescents seen at the King Abdulaziz Medical City (KAMC), Riyadh. Because osteomalacia and rickets constitute the same entity, the term osteomalacia will be used for future discussion. A retrospective file review was performed on all adolescents (10-16 years) with osteomalacia, defined as alkaline phosphatase levels ≥500 IU/L, seen at the KAMC, Riyadh, from 2000 to 2006. We recorded the signs and symptoms, dietary history and amount of sun exposure at presentation. A total of 135 patients were found to fit the inclusion criteria for the study. Of them, 57 had nutritional causes, with a mean age of 13.2 years, and included 32 females. At diagnosis, 22 patients were found to have bone pain, 10 had bone deformities, eight had pathological fractures and 17 were asymptomatic. Secondary causes for osteomalacia were found in 59 cases who had liver and renal disease and in 19 other patients who were on medications such as anticonvulsants and steroids, which are known to cause osteomalacia. Our study indicates that osteomalacia is a significant health burden that deserves special attention. Bone pain is the most common presenting symptom at diagnosis. Because of the high risk of osteomalacia associated with the use of anticonvulsants and steroids, it is advised that all patients on these drugs should be routinely screened for secondary osteomalacia.

Clinical Presentations of Vitamin D Deficiency in Children at King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia: A Cross-Sectional Survey

“…Other previous studies in Saudi Arabia found that the most common complaint was back pain [1] and acute hypocalcemia manifestations [12]. The least common presentation of vitamin D deficiency was pathological fractures, according to research in another study [7]. Our results differed from these reports, because we found that joint pain was the most common presentation of vitamin D deficiency in our cases.…”

“…The clinical manifestations of vitamin D deficiency are varied and may include seizures, tetany, respiratory infections, knock-knee or bow-legged, abnormalities of the costochondral joints, and frontal bossing of the skull [9]. In a previous study at the King Abdul-Aziz Medical City in Riyadh, bone pain was found in 38% of cases [7], but in our study we found this symptom in 23.2% of cases. A study in Glasgow found that 1% of cases had fatigue and 2% experienced developmental delays [10].…”

“…Saudi Arabia has a high prevalence of vitamin D deficiency and most cases are asymptomatic. In children who do have symptoms, these symptoms are often nonspecific, which can make the diagnosis difficult [1,7,8]. Over all, this study highlights need for knowing the commonest symptoms for vitamin D deficiency.…”

“…Children with vitamin D deficiency present with bone pain, muscle weakness, bowed legs, rachitic rosary, frontal bossing of the skull, knock-knees, swelling of the ends of long bones, widened wrist and ankle joints, poor growth, delayed or slow motor development, delayed developmental milestones, delayed dentition, fits, and, in severe cases, pathological fractures [2,5]. Children with life-threatening hypocalcemia may present with convulsions, tetany, and paresthesia [2,6,7]. Saudi Arabia has a high prevalence of vitamin D deficiency and most cases are asymptomatic.…”

Russian Association of Endocrinologists recommendations for diagnosis, treatment and prevention of vitamin D deficiency in adults

“…В связи с тем, что эпифи-зарные зоны роста у взрослых закрыты, запасы кальция в скелете сравнительно большие для пре-дотвращения деформаций вследствие дефекта ми-нерализации, развитие остеомаляции зачастую дли-тельное время не диагностируется. Ее проявления-ми могут быть изолированные или генерализован-ные боли, неприятные ощущения в костях и мыш-цах [50,51].…”