Cases Of Osteomalacia Research Articles

Prevalence of biochemical osteomalacia in adults undergoing vitamin D testing.

Prolonged severe vitamin D deficiency can cause osteomalacia, but the 25-hydroxyvitamin D (25OHD) concentration below which this occurs is unknown. We investigated the prevalence of biochemical osteomalacia in adults with a measurement of 25OHD. 25OHD results between 1/1/2009 and 15/6/2020 were obtained from the regional laboratory database, together with measurements of serum calcium, parathyroid hormone (PTH) and alkaline phosphatase (ALP) within 6months of the index 25OHD. We defined biochemical osteomalacia as all 3 of: albumin-adjusted serum calcium (aCa)<2.0mmol/L, PTH>7.3pmol/L and ALP>150IU/L. Possible osteomalacia was 2/3 criteria with the other test not done. 25OHD measurements associated with significant renal impairment, elevated hepatic transaminases or hypercalcaemia were excluded. 110,046 25OHD measurements were identified over the 11.5years period. After removal of ineligible measurements, 42,171 25OHD measurements from 32,386 individuals with at least 2 of aCa, PTH and ALP were included in analyses. Median 25OHD was 63nmol/L; 8% were <25nmol/L, and 33% were <50nmol/L. Five index 25OHD measurements met the definition of biochemical osteomalacia, and another 11 were possible osteomalacia. After reviewing available clinical records for these 16 episodes, we classified 9 cases as osteomalacia and 7 as other diagnoses. Thus, the prevalence of biochemical osteomalacia was 0.02% (9/42,171) for 25OHD measurements and 0.23% (8/3432) for 25OHD<25nmol/L. All cases of osteomalacia with 25OHD measurements prior to supplementation had 25OHD≤18nmol/L. The prevalence of biochemical osteomalacia is very low, even in individuals with 25OHD<25nmol/L.

Frh. von dem Bussche-Haddenhausen. —Die in den Jahren 1890 bis 1894 in der Frauenklinik zu Göttingen operirten Fälle von Osteomalacie. (Arch. F. Gyn., Bd. XLIX, Hft. 1). Cases of osteomalacia operated on in the Göttingen Clinic, in the period from 1890 to 1894

Having transferred the history of the disease 6 cases of osteomalacia, in which castration was performed (in 5 cases), resp. operation Porro (in 1 case), the author is trying to throw some light on the ethiology, pathogenesis and therapy of this suffering.

Osteomalation under the mask of spondyloarthritis

Objective. To demonstrate the possibility of having a spondyloarthritic mask of osteomalacia in patients of both sexes.Materials and methods. Two clinical cases of osteomalacia occurring under the mask of spondyloarthritis in patients treated at the Clinical Rheumatology Hospital of Saint-Petersburg, Russia, as well as similar cases described in the literature, were analyzed.Results. In the cases described, patients were diagnosed with a disease from the group of spondyloarthritis based on a number of individual symptoms, such as pain in the lower back and stiffness, as well as instrumental examination data. At the same time, with in-depth evaluation, the pain in the lower back did not did not met to the inflammatory pain ASAS criteria, and there were also no signs of general laboratory activity of the disease. The conventional therapy for spondyloarthritis was ineffective. With the re-evaluation of clinical, laboratory and instrumental data, the diagnosis was changed to osteomalacia. Appointment of adequate therapy with vitamin D after a review of the diagnosis resulted in both a regression of clinical symptoms and an improvement in laboratory parameters.Conclusions. If the patient has pain in the lower back, especially without clear signs of inflammatory, no signs of general laboratory activity, further examination is necessary to clarify possible osteomalacia. Spondyloarthritis should be only diagnosed in cases with the secondary nature of symptoms excluded.

Gender-related vitamin D deficiency in a Dutch 19th century farming community

The most common cause of vitamin D deficiency is inadequate dermal exposure to sunlight. Residual rickets is nonadult vitamin D deficiency still evident in an adult individual, whereas osteomalacia occurs in adulthood. Previous research on the Beemster population, a 19th century rural community in the Netherlands, identified rickets in 30.4% of the nonadults between the ages of two and four years (n=7/23). Because the sex of these nonadults was not known it was not possible to determine if there were differences between boys and girls. To overcome this gap in our knowledge, the aim of this paper is to determine if there are gender related differences in vitamin D deficiency in the Beemster skeletal collection, based on adults with residual rickets and osteomalacia. Out of 200 adults (100 females; 100 males) no cases of osteomalacia were detected. However, there were 29 cases of residual rickets (14.5%), with 21 of those cases in females (21.0%; 21/100). A complex interplay of multiple factors is proposed to have affected vitamin D levels in nonadults, including sociocultural variables such as gender-based labour norms. This research highlights the importance of continuing to explore gender-based health differences in past populations.

Renal Osteodystrophy in Predialysis and Hemodialysis Patients: Comparison of Histologic Patterns and Diagnostic Predictivity of Intact PTH

Background: Comparison of renal osteodystrophy in predialysis and hemodialysis has been rarely reported. Distinct patterns of renal osteodystrophy could be found in these conditions. In addition the use of parathyroid hormone (PTH) and other markers for noninvasive diagnosis may result in different predictive values in predialysis and hemodialysis patients. Methods: 79 consecutive patients with conservative chronic renal failure and 107 patients on hemodialysis were studied. All patients were subjected to bone biopsy for histological and histomorphometric evaluation. The patients had no exposure to aluminium before dialysis and relatively low exposure while on hemodialysis. Results: In the predialysis patients, bone biopsies showed 9 cases of adynamic bone disease (ABD) and 8 cases of osteomalacia (OM), 50 patients with mixed osteodystrophy and 2 cases of hyperparathyroidism. Among the hemodialysis patients 12 cases had ABD, 3 cases OM, 30 mixed osteodystrophy, and 61 patients hyperparathyroidism. In the predialysis patients with chronic renal failure, bone aluminium was on average 4.5 mg/kg dry weight, while in dialysis patients the average value was 35.4 mg/kg dry weight. Discriminant analysis of low turnover osteodystrophy (ABD and OM) by intact PTH showed higher accuracy in dialysis than in predialysis patients. Correlation studies of intact PTH versus bone formation rate, osteoblast surface/bone surface and osteoclast surface/bone surface showed significantly steeper slopes in dialysis than in predialysis patients, which indicates that bone resistance to PTH is more marked in predialysis patients. Conclusions: The prevalence of ABD and OM in the geographic area investigated is lower than in other reports. Aluminium exposure does not seem to be the cause of low turnover osteodystrophy in the present population. The predictive value of intact PTH in the noninvasive diagnosis of renal bone disease is higher in hemodialysis patients than in predialysis patients. Predialysis chronic renal failure, when compared to the dialysis stage, seems to be characterized by resistance of bone tissue to PTH.

Renal Osteodystrophy

Renal osteodystrophy is a complex disorder which can be divided into five distinct bone histologic subtypes: mild bone disease, hyperparathyroid bone disease, mixed bone disease, osteomalacia, and low-turnover bone disease. Hyperparathyroidism develops in renal failure due to two principal abnormalities: l,25(OH)2D3 deficiency and hyperphosphatemia. Treatment of these problems is important in order to prevent hyperparathyroidism. Most cases of osteomalacia, mixed bone disease, and low-turnover bone disease are influenced by aluminum status and parathyroid hormone. Aluminum-associated bone disease can be treated with termination of aluminum exposure and/or deferoxamine therapy. Numerous diagnostic pitfalls exist in the evaluation of renal osteodystrophy, and the bone biopsy is extremely important to avoid these problems and plan proper therapy.

貧血に対する鉄剤の静注により生じたと思われる骨軟化症の３例

Three cases of osteomalacia caused by intravenous administration of saccharated ferric oxide were reported. Three cases were female with ages of 51, 55 and 61 years old. They received saccharated ferric oxide intravenouslly for anemia, just before having back pain, low back pain and hip joint pain due to osteomalacia. Their serum Ca and P were low and alkalinphosphatase was high. At their undecalcified thin sections of the iliac bone, osteoid surface and osteoid bone volume were increased, and little tetracycline had been taken, so that mineralization had been disturbed.

HIGH PREVALENCE OF UNRECOGNIZED OSTEOMALACIA IN HOSPITAL PATIENTS WITH RHEUMATOID ARTHRITIS

A consecutive series of 31 patients with rheumatoid arthritis (RA) admitted over a 6-month period to the rheumatology unit of a District General Hospital were screened for possible osteomalacia. Transiliac bone biopsies were performed in 14 patients where the above diagnosis was suspected, yielding four (12.9%) cases of osteomalacia. All affected patients were elderly women who had a poor diet and were virtually housebound. Additional risk factors in two cases were partial gastrectomy and occult coeliac disease. Biochemical screening was of limited value in differential diagnosis, since elevated serum alkaline phosphatase levels were noted in both osteomalacic and non-osteomalacic patients. This study indicates that, in the West of Scotland at least, osteomalacia is a common, easily overlooked and treatable cause of morbidity in elderly patients with RA.

Metabolic bone disease among in-patients with rheumatoid arthritis.

Twenty-five consecutive in-patients who had suffered from rheumatoid arthritis for at least five years were investigated radiologically, histologically and biochemically for evidence of metabolic bone disease. Dietary intake of vitamin D was universally well below recommended levels. Serum 25-hydroxycholecalciferol (25-OHD) concentrations did not correlate with dietary intake of vitamin D but correlated significantly with a sunlight exposure score (p less than 0.01). Despite seven patients having 25-OHD levels below the normal reference range, no cases of osteomalacia were found. Pathological fractures, often initially unrecognized, had occurred in the lower limb bones of seven patients in the previous five years. Those with fractures of the leg bones had evidence of more pronounced osteoporosis of the axial skeleton radiologically and histologically and five of the seven had been taking oral corticosteroids. There was close agreement between qualitative histological assessment of osteoporosis and radiographic evidence of vertebral collapse and those with the severest osteoporosis had lower serum levels of 25-OHD than the rest (p less than 0.02). Ten subjects had reduced xylose absorption tests, although frank malabsorption was not found, and in five patients studied the jejunal mucosa was normal.

The Classic

Olaus Jacob Ekman, chief surgeon to the Swedish Royal Cavalry Regiment of Southern Scane, defended his thesis for the degree of doctor of medicine before the faculty of medicine of the University of Upsala on May 10, 1788. His thesis,* a description of various cases of osteomalacia, contains the first account of hereditary bone fragility traced through three generations and includes a good description of the members afflicted with osteogenesis im-perfects. His account had been buried in the literature, unnoticed, until resurrected by Knud S. Seedorf. It has been translated and published by Seedorf as a part of his monograph on osteogenesis imperfects.** As an army surgeon, Ekman's career and even his life may have been consumed in the disastrous northern wars of Charles XII against Russia's Peter the Great. Johann F. Georg C. Lobstein (1777–1835) was born in Giessen, where his father was a professor of theology. He was educated in Strasbourg, and after serving in the revolutionary armies, received his degree of doctor of medicine in 1803. He specialized in obstetrics and pathological anatomy. In 1819, the University of Strasbourg established an Institute of Pathology, the first of its kind in France, and Lobstein was made Professor of Pathologic Anatomy. His major work, Traite d'anatomie pathologique, Paris and Strasbourg, 1829, 1833, contained a section in which he discussed the fragility of bones, or osteopsathyrosis. “Osteopsathyrosis is particularly remarkable at the extremes of life, infancy and decrepitude. In these age groups, the insufficiency of the bones can result in fractures. I have seen three children from the same family who, in the space of five years, had eight fractures of the arms and legs following trifling falls.” It is this comment that, until now, has been considered to be the first description of osteogenesis imperfecta. With the discovery of Ekman's earlier and more extensive description, Lobstein must be content to be known as the first to introduce the term “arteriosclerosis” into medical terminology.

Osteomalacia: uncommon causes

Osteomalacia is an abnormality of bone characterized by an accumulation of increasing matrix and epiphyseal cartilage, which fails to calcify or does so extremely slowly. Diagnosis is made histologically by widened osteoid seams and is radiologically dependent upon the demonstration of looser zones or pseudofractures, [1 , 2]. Osteomalacia may result from various etiobogic factors that may be divided into three major groups as by Mankin [3]: 1 .-Deficiency states, including primary vitamin D deficiency (lack of intake or ultraviolet exposure), calcium or phosphorus deficiency, and chelators (oxalate, phosphate). 2 .-Absorbtive defects, including gastric, pancreatic, intestinal, and hepatobiliary disorders, including postsurgical defects. 3.-Renal disease, including tubular defects or renal tubular acidosis from congenital abnormalities. Acquired disease can cause renal tubular acidosis or renal osteodystrophy. Miscellaneous causes of osteomalacia include fibrous dysplasia, neurofibromatosis, and osteopetrosis [4]; medication including Dilantin and phenolphthalein [5]; neoplasms, both benign and malignant, of either bone or soft tissues; and unclassified causes, including hypophosphatasia, axial osteomalacia [4], fibrogenesis imperfecta osseum [5], and fluoride ingestion [4]. The cause of the osteomalacia is usually obvious when the radiographs are positive; occasionally, the underlying disorder is occult and familiarity with the various etiologies and associated diseases may enable the radiologist to suggest the correct diagnosis. Our recent experience with two cases of osteomalacia in which the discovery of the underlying abnormality led to profound changes in therapy and prognosis form the basis for this report.

Letter: Neuromuscular function in secondary hyperparathyroidism.

Excerpt To the editor: In a recent paper (Ann Intern Med82:474-483, 1975), six cases of osteomalacia, or secondary hyperparathyroidism, or both, with evaluations of neuromusculature function were d...

Two Cases of Osteomalacia

We are reporting two cases of osteomalacia. Case I. Twenty-eight years old a female. She complained of dullness of her both legs from 13 years ago. This symtome has increased, recently she complained of disturbance of gait and of pain in her trunks and extremities.The roentogenograms of her bones showed demineralization and lots of fractures. The serum calcium was 4.0mEq/l, the serum phosphorus was 1.4mg/dl and serum alkaline phoshatase was 21.4K. A unit. Case 2. Seventy-six years old a female. She complained of pain her both calcaneus in the walking. The raentogenogram of her feet showed porosis, the serum calcium was 4, 4mEq/dl, and serum alkaline phosphatase was 38.8K. A unit.Two cases have been given Vitamin -D 2.5-5.0 miligram for two or three months.There has been improved on the biochemical examination and raentogenographic views.

Full balances of trace elements in two cases of osteomalacia.

Abstract Metabolic studies were performed in a normal subject and in two cases of osteomalacia with respect to the balances of the following 21 trace elements: As, Au, Ba, Br, Cd, Ce, Co, Cr, Cs, Cu, Fe, Hg, La, Mo, Rb, Sb, Sc, Se, Sm, W and Zn. Neutron activation analysis combined with a recently developed ion exchange technique was used. The results suggest that the metabolism of some of these elements is influenced not only by the metabolic disorder, but also by the substitution therapy used.

Acute effects of calcium infusion on hydroxyproline

Acute effects of 4-h calcium infusion on plasma levels and urinary excretion of total hydroxyproline have been investigated. During the 3-h postinfusion period a decrease of hydroxyproline excretion was found in 8 normal subjects, 8 cases of primary hyperparathyroidism and in 8 cases of osteomalacia, the average per cent decrease being similar in all three groups, irrespective of high initial values in the latter two. The average excretion and the effect of calcium infusion thereon was lower in 8 cases of chronic uremia. In all four groups studied a slight decrease of plasma hydroxyproline was observed which, in most cases, could not account for the changes in urinary excretion. The acute changes of urinary excretion of total hydroxyproline do not differentiate between primary and secondary hyperparathyroidism in cases without grossly abnormal renal function.

20 Tetracycline-Based Studies of Bone Dynamics in Rib of 6 Cases of Osteomalacia

RAMSER, J. R. M.D.*; FROST, H. M. M.D.*; FRAME, B. M.D.†; ARNSTEIN, A. R. M.D.†; SMITH, R. M.D.† Author Information

The Etiology of Osteitis Fibrosa Cystica

One of the intriguing features of medicine is its ever changing horizon. The etiology of more and more diseases is becoming apparent as the gaps in our accumulated knowledge are bridged. A little over a quarter of a century ago, the first accurate description of osteitis fibrosa cystica was given by von Recklinghausen. Within the past few years, work has been done which has apparently demonstrated its etiology to be of an endocrine nature. This discovery has been prefaced, as usual, by the disclosure of a number of findings by independent workers, which dovetail so that the chain of events would seem to be complete. The first important event in the solution of this problem took place in 1904, when Askanazy described a case of osteitis fibrosa cystica associated with a parathyroid tumor. Erdheim, in 1907, found parathyroid enlargement in three cases of osteomalacia, but he felt that the parathyroid enlargement was the effect, and not the cause, of the disease. In 1915, Schlagenhaufer proposed the extirpati...

The Osseous Changes in Hyperparathyroidism Associated with Parathyroid Tumor: A Roentgenologic Study

ERDHEIM first pointed out the significance of the parathyroid glands in relation to metabolism of calcium in the skeletal system. His observations of more or less marked increase in the parenchyma of the parathyroid glands in osteomalacia have since been confirmed by many observers, although his interpretation of this change as a form of compensatory hypertrophy has led to much discussion. Verbitz, Langhans, and Kocher, in 1907, all reported association with a parathyroid tumor of multiple brown tumors of bone. Strada, in 1909, observed a woman, aged 54 years, with osteomalacia who had hyperplasia of the parathyroid glands. In three cases of senile osteomalacia, however, Strada observed that the parathyroid glands were normal. Bauer, in 1911, and Todyo, in 1912, found hyperplasia of the parathyroid glands in cases of osteomalacia and osteoporosis. Molineus, in 1913, found hyperplasia of the parathyroid glands accompanying three cases of osteomalacia with multiple brown tumors of the bone, multiple fractures, and infractions. In the same year, Paltauf and Askanazy reported a case of parathyroid tumor associated with osteitis fibrosa, multiple brown tumors of bone, and formation of cysts. Schlagenhaufer, in 1915, observed a man, aged 43 years, with hypertrophy of the left parathyroid gland and marked osteitis fibrosa. Maresch, in 1916, reported the association of enlargement of the parathyroid glands with osteitis fibrosa cystica in one case, with osteomalacia in one case, and with multiple cystic lesions in several bones in one case. The parathyroid bodies were macroscopically hypertrophied in eight cases of senile osteomalacia and in twenty-eight cases of osteoporosis, but in five cases of osteitis deformans the changes in the parathyroid gland s were less marked. Günther, in 1922, stated that almost all patients who have multiple brown tumors of the bones also have tumorous enlargement of the parathyroid glands. In the same year, Strauch reported the case of a woman aged 27 years who had marked puerperal osteomalacia, and a large parathyroid tumor. Danisch, in 1925, could demonstrate parathyroid tumors in only two of twenty cases of senile osteoporosis. Hoffheinz, in 1925, reviewed forty-five cases of enlargement of the parathyroid glands, in twenty-five of which there were skeletal changes, and in seventeen of these, osteofibrosa was present. Mandl, in 1925, was the first to report roentgenologic data before and after operation in a case of parathyroid tumor. Before operation, osteoporosis and a fibrous appearance of the bones were present. Four months after operation, increased calcification was observed. Richardson, Aub, and Bauer, in 1929, reported the case of a man, aged 34 years, in which roentgenograms disclosed generalized osteoporosis, with rather coarse bone trabeculæ. Fractures had occurred and had healed normally.

Parathyroid hypertrophy and hyperplasia in fowls

Physiological overgrowth of the parathyroid glands in mammals has been very rarely observed. Erdheim,1 Bauer2 and Strada3 have recently described its occurrence in man in association with some cases of osteomalacia. Three instances of undoubted general parathyroid enlargement in bitches in association with lactation have come under my observation.In the reports of partial removal and of transplantation of mammalian parathyroids, particularly in dogs, one of the most characteristic features has been the absence of any noteworthy compensatory enlargement of the remaining portion within the time limits in which other tissues, like the thyroid, heart muscle, kidney, etc., react to artificially induced insufficiencies.In the course of some experiments with the thyroid gland in fowls in 1910, I observed several instances of marked enlargement of the parathyroids independent of the changes occurring in the thyroid glands. These parathyroid changes were found in fowls which had been fed with maize and wheat for p...