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Osteomalacia revisited : A report on 28 cases.
MedLine Citation:
PMID:  20949298     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
The aim of this study was to analyse the clinical manifestations and the most frequent causes of osteomalacia (OM) in a group of 28 patients diagnosed with this disorder during a 20-year period. OM was diagnosed by bone biopsy and/or by Bingham and Fitzpatrick criteria (two of the following: low calcium, low phosphate, elevated total alkaline phosphatase [total AP] or suggestive radiographs). Of these patients, 13 had vitamin D deficiency OM (VD-OM), 14 hypophosphatemic OM (HypoP-OM) and one had OM-associated hypophosphatasia. Deficient sun exposure and celiac disease were the most frequent etiologies of VD-OM, whereas most HypoP-OM were hereditary forms. The main clinical symptoms were polyarthralgias (89%), frequently associated with fractures (75%). Fifty seven percent had densitometric criteria of osteoporosis. Patients with VD-OM showed significantly higher total AP and PTH serum values, but lower vitamin D, serum calcium, calciuria and bone mass than patients with HypoP-OM. Conversely, HypoP-OM patients had significantly lower serum phosphate and higher phosphaturia than patients with VD-OM. Briefly, high total AP, low serum calcium and low serum phosphate were observed in 85%, 65% and 15%, respectively, of patients with VD-OM, being observed in 64%, 14% and 100%, respectively, of HypoP-OM patients. Nearly 50% of these latter showed increased FGF23 levels. In conclusion, in this study, the frequencies of HypoP-OM and VD-OM were similar. The most frequent laboratory abnormalities were increased total AP and decreased serum phosphate. A urinary calcium loss of less than 50 mg/dl was highly discriminatory for VD-OM and a serum phosphate less than 2.3 mg/dl was also high discriminatory for HypoP-OM. Low densitometric values and fractures were frequent among these patients.
Authors:
Laia Gifre; Pilar Peris; Ana Monegal; Maria Jesús Martinez de Osaba; Luisa Alvarez; Núria Guañabens
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Publication Detail:
Type:  Journal Article     Date:  2010-10-15
Journal Detail:
Title:  Clinical rheumatology     Volume:  30     ISSN:  1434-9949     ISO Abbreviation:  Clin. Rheumatol.     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-04-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8211469     Medline TA:  Clin Rheumatol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  639-45     Citation Subset:  IM    
Affiliation:
Metabolic Bone Diseases Unit, Service of Rheumatology, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain, lgifre@clinic.ub.es.
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