Changes in Bone Mineral Density Following Treatment of Osteomalacia

Department of Endocrinology and Diabetes, Indraparastha Apollo Hospital, Sarita Vihar, New Delhi, India.
Journal of Clinical Densitometry (Impact Factor: 2.03). 01/2006; 9(1):120-7. DOI: 10.1016/j.jocd.2005.11.001
Source: PubMed


Osteomalacia is characterized by defective mineralization and low bone mineral density (BMD). Clinical and biochemical improvements typically occur within a few weeks of starting treatment, though the bone mineral deficits may take longer to correct. We report a case series of 26 patients with frank osteomalacia (pseudo fractures on X-rays, elevated serum total alkaline phosphatase and parathyroid hormone, normal/low serum calcium and phosphorus, and low serum 25-hydroxy vitamin D) who were followed-up for changes in BMD during treatment using dual- energy X-ray absorptiometry (DXA). There were 23 patients with nutritional vitamin D deficiency, 2 with malabsorption syndrome, and 1 with renal tubular acidosis. All patients were treated with vitamin D and calcium; the 3 patients with associated disorders were treated accordingly. At baseline, there was low BMD at all sites tested. The rate of increase in vertebral and hip BMD was rapid in the initial few months, which subsequently slowed down. In contrast to the large increases in BMD at the femoral neck and lumbar spine, the radial BMD did not recover. At the time when most patients had marked clinical and biochemical improvement (2.8+/-1.4 mo), the vertebral and hip BMD, although improved from baseline, had not completely recovered. Bone loss at the forearm (cortical site) appears to be largely irreversible. Although the clinical correlates of these changes are presently unclear, BMD measurements are useful in assessing the initial severity of bone loss as well as the response to therapy.

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    • "It is seen that a large population of the healthy adult population has low or borderline low serum 25(OH)D levels which further increases the risk of falls and fracture.[34567] Vitamin D plays a critical role in bone health.[1589101112] Optimization of vitamin D status is therefore an essential component of preventing and managing osteoporosis especially in vulnerable groups like postmenopausal women.[13] "
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    ABSTRACT: To compare the effect of two different doses (500 and 1000 IU/day) of oral vitamin D3 (cholecalciferol) on serum 25-hydroxy vitamin D [25(OH)D] levels in apparently healthy postmenopausal Indian women. Serum 25(OH)D, calcium with albumin, phosphorus, and alkaline phosphatase were measured in 92 apparently healthy postmenopausal women. The subjects were randomly assigned to one of the three groups and received supplementation for 3 months each. Each group received 1000 mg calcium carbonate daily while groups B and C received 500 and 1000 IU of cholecalciferol in addition, respectively. The tests were repeated after 3 months. At baseline, 83.7% subjects had vitamin D deficiency (≤20 ng/mL). The difference in the percentage change in mean serum 25(OH)D levels from baseline in group A (-30.5 ± 5.3%), group B (+8.9 ± 19.7%), and in group C (+97.8 ± 53.3%) was statistically significant (P < 0.001) between the three groups. Serum 25(OH)D level >20 ng/mL was achieved in 4.7% (1/21), 16% (4/25), and 66.67% (12/18) subjects in groups A, B, and C, respectively. No significant change was found in serum calcium, phosphorus, and alkaline phosphatase levels at 3 months in either of the groups from baseline. Standard dose of cholecalciferol available in "calcium tablets" (250 IU per 500 mg calcium carbonate) is not adequate for achieving optimum serum 25(OH)D levels in Indian postmenopausal women. Higher dose of vitamin D supplementation with 1000 IU/day (500 IU per 500 mg calcium carbonate) daily is superior to the standard dose therapy. For achievement of optimum serum 25(OH)D levels (>30 ng/mL) in Indian postmenopausal women, still higher doses of vitamin D are likely to be required.
    03/2013; 17(5):883-889. DOI:10.4103/2230-8210.117237
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    • "Improvement of BMD in such a relatively short period is consistent with Viapiana et al. [43] who found that a 3 months period of intensive nutritional therapy in anorexia nervosa was sufficient to show the significant improvement in BMD. Similarly, Bhambri et al. [44] found that BMD measured by DXA was significantly improved but not to base line after therapy for 2.8+/−1.4 months. "
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    • "Prior to recent investigations in metabolic bone disease and bariatric surgery, improvement in bone density as a result of vitamin D supplementation had been demonstrated however, the changes were small, of questionable clinical significance, and occurred exclusively in trabecular bone [60]. "
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