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Severe Proximal Myopathy with Remarkable Recovery after Vitamin D Treatment

Published online by Cambridge University Press:  02 December 2014

Yousef A. Al-Said ,
Hiyam S. Al-Rached ,
Hussien A. Al-Qahtani  and
Mohammed M.S. Jan
Yousef A. Al-Said
Affiliation:
Department of Neurosciences, King Faisal Specialist Hospital & Research Center
Hiyam S. Al-Rached
Affiliation:
Department of Neurosciences, King Faisal Specialist Hospital & Research Center
Hussien A. Al-Qahtani
Affiliation:
Department of Internal Medicine, King Abdulaziz Medical City
Mohammed M.S. Jan*
Affiliation:
Department of Neurosciences, King Faisal Specialist Hospital & Research Center Department of Pediatrics, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
*
Pediatric Neurology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center, MBC J-76, PO Box 40047, Jeddah 21499, Kingdom of Saudi Arabia
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Abstract

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Background:

Osteomalacia is an uncommon cause of muscle weakness. Our objectives were to describe features of myopathy associated with Vitamin D deficiency and examine the contributing factors leading to osteomalacic myopathy in our region.

Methods:

Patients identified retrospectively for the six year period ending in December 2006 with the diagnosis of osteomalacia and/or Vitamin D deficiency associated proximal muscle weakness were included. They were followed in three major centers in western Saudi Arabia. Clinical, biochemical, radiological, and electrophysiological findings were collected before and after Vitamin D treatment by chart review.

Results:

Forty seven female patients aged 13-46 years (mean 23.5, SD 4.5) were included. All were veiled and covered heavily when outside the house for social and cultural reasons. Only eight (17%) had adequate varied diet with daily milk ingestion. All patients presented with progressive proximal muscle weakness lasting 6-24 months (mean 14) prior to our evaluation. The weakness was severe in six (13%) patients leading to wheel chair bound states. Associated musculoskeletal pain involving the back, hips, or lower limbs was common (66%). Osteomalcia was the referral diagnosis in only 11 patients and the remaining 36 (77%) patients were misdiagnosed. All patients had metabolic and radiological profiles suggestive of osteomalacia. Remarkable recovery was documented in all patients following oral cholecalciferol and calcium supplementation.

Conclusions:

Vitamin D deficiency is an important treatable cause of osteomalacic myopathy in Saudi Arabia. The diagnosis is frequently delayed or missed. Screening for Vitamin D deficiency in patients with acquired myopathy is needed to identify this treatable disorder.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 36 , Issue 3 , May 2009 , pp. 336 - 339
Copyright
Copyright © The Canadian Journal of Neurological 2009

References

1. Swash, M, Schwartz, MS, Sargeant, MK. Osteomalacic myopathy: an experimental approach. Neuropathol Appl Neurobiol. 1979;5(4): 295–302.CrossRefGoogle ScholarPubMed
2. Kaur, K, Singh, A, Prabhakar, BR. Osteomalacic myopathy. J Indian Med Assoc. 1980;74(12):238–40.Google Scholar
3. Reginato, AJ. Musculoskeletal manifestations of osteomalacia. Rev Rhum Engl Ed. 1997;64(6):107–13.Google Scholar
4. Skaria, J, Katiyar, BC, Srivastava, TP, Dube, B. Myopathy and neuropathy associated with osteomalacia. Acta Neurol Scand. 1975;51(1):37–58.CrossRefGoogle ScholarPubMed
5. Sedrani, SH. Low 25-hydrxy Vitamin D and abnormal calcium concentration in Saudi Arabia: Riyadh region. Ann Nutr Metab. 1984;28(3):181–5.CrossRefGoogle Scholar
6. Sedrani, SH, Elidrissy, AWTH, Elarabi, KM. Sunlight and Vitamin D status in normal Saudi subjects. Am J Clin Nutr. 1983;38:129–32.Google Scholar
7. Gullu, S, Erdogan, MF, Uysal, AR, Baskal, N, Kamel, AN, Erdogan, G. A potential risk for osteomalacia due to sociocultural lifestyle in Turkish women. Endocr J. 1998;45(5):675–8.CrossRefGoogle ScholarPubMed
8. Holick, MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004;80(6):1678–88.Google Scholar
9. Al Faraj, S, Al Mutairi, K. Vitamin D deficiency and chronic low back pain in Saudi Arabia. Spine. 2003;28(2):177–9.CrossRefGoogle ScholarPubMed
10. Bingham, CT, Fitzpatrick, LA. Noninvasive testing in the diagnosis of osteomalacia. Am J Med. 1993;95:519–23.Google Scholar
11. Plotnikoff, GA, Quigley, JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc. 2003;78(12):1463–70.CrossRefGoogle ScholarPubMed
12. Holick, MF. Vitamin D: a millennium perspective. J Cell Biochem. 2002; 88:269–307.Google Scholar
13. Kaplan, FS, Soriano, S, Fallon, MD, Haddad, JG. Osteomalacia in a night nurse. Clin Orthop Relat Res. 1986;205:216–21.CrossRefGoogle Scholar
14. Finch, PJ, Ang, L, Eastwood, JB, Maxwell, JD. Clinical and histological spectrum of osteomalacia among Asians in South London. Q J Med. 1992;83:439–11.Google Scholar
15. Guzel, R, Kozanoglu, E, Guler-Uysal, F, Soyupak, S, Sarpel, T. Vitamin D status and bone mineral density of veiled and unveiled Turkish women. J Women Health Gend Based Med. 2001;10(8):765–70.Google Scholar
16. El Sonbaty, MR, Abdul-Ghaffar, NU. Vitamin D deficiency in veiled Kuwaiti women. Eur J Clin Nutr. 1996;50(5):315–8.Google Scholar
17. Erkal, MZ, Wilde, J, Bilgin, Y, Akinci, A, Demir, E, Bodeker, RH, et al. High prevalence of Vitamin D deficiency, secondary hyperparathyroidism and generalized bone pain in Turkish immigrant in Germany: identification of risk factors. Osteoporos Int. 2006;17(8):1133–40.Google Scholar
18. Alagol, F, Shihadeh, Y, Boztepe, H, Tanakol, R, Yarman, S, Azizlerli, H, et al. Sunlight exposure and Vitamin D deficiency in Turkish women. J Endocinol Invest. 2000;23(3):173–7.Google Scholar
19. Reed, SD, Laya, MB, Melville, J, Ismail, SY, Mitchell, CM, Ackerman, DR. Prevalence of vitamin D insufficiency and clinical associations among veiled East African women in Washington state. J Women’s Health. 2007;16(2):206–13.CrossRefGoogle ScholarPubMed
20. Berger, JR. The neurological complications of bariatric surgery. Arch Neurol. 2004;61(8):1185–9.CrossRefGoogle ScholarPubMed
21. Koffman, BM, Greenfield, LJ, Ali, II, Pirzada, NA. Neurologic complications after surgery for obesity. Muscle Nerve. 2006;33 (2):166–76.CrossRefGoogle ScholarPubMed
22. Byrne, MF, Razak, AR, Leader, MB, Sheehan, KM, Patchett, SE. Disabling osteomalacic myopathy as the only presenting feature of celiac disease. Eur J Gastroenterol Hepatol. 2002;14(11): 1271–4.Google Scholar
23. Kozanoglu, E, Basaran, S, Goncu, MK. Proximal myopathy as an unusual presenting feature of celiac disease. Clin Rheumatol. 2005;24(1):76–8.Google Scholar
24. De Boer, WA, Tytgat, GN. A patient with osteomalacia as single presenting symptom of gluten-sensitive enteropathy. J Intern Med. 1992; 232:81–5.CrossRefGoogle ScholarPubMed
25. Dent, CE, Richens, A, Rowe, DJ, Stamp, TC. Osteomalacia with long-term anticonvulsant therapy in epilepsy. Br Med J. 1970;4(5): 69–72.CrossRefGoogle ScholarPubMed
26. Hoikka, V, Alhava, EM, Karjalainen, P, Keränen, T, Savolainen, KE, Riekkinen, P, et al. Carbamazepine and bone mineral metabolism. Acta Neurol Scand. 1984;70(2):77–80.Google Scholar
27. Russell, JA. Osteomalacic myopathy. Muscle Nerve. 1994;17: 578–11.Google Scholar
28. Glerup, H, Mikkelsen, K, Poulsen, L, Hass, E, Overbeck, S, Andersen, H, et al. Hypovitaminosis D myopathy without biochemical signs of osteomalacic bone involvement. Calcif Tissue Int. 2000;66(6):419–24.Google Scholar
29. Pfeifer, M, Begerow, B, Minne, HW. Vitamin D and muscle function. Osteoporos Int. 2002;13(3):187–94.CrossRefGoogle ScholarPubMed
30. Russell, JA. Osteomalacic myopathy. Muscle Nerve. 1994;17(6): 578–80.Google Scholar
31. Bingham, CT, Fitzpatrick, LA. Noninvasive testing in the diagnosis of osteomalacia. Am J Med. 1993;95:519–22.Google Scholar
32. Kim, S, Park, CH, Chung, YS. Hypophosphatemic osteomalacia demonstrated by Tc-99m MDP bone scan: a case report. Clin Nucl Med. 2000;25(5):337–40.Google Scholar
33. Frame, B, Parfitt, AM. Osteomalacia: current concepts. Ann Intern Med. 1978;89(6):966–82.CrossRefGoogle ScholarPubMed