In 1922, at Johns Hopkins University in Baltimore, Professor McCollum discovered a factor, which has since been referred to as vitamin D, following the alphabetical order of the other vitamins identified up to that time. It is capable of curing rickets in children and osteomalacia in adults. Diseases in which, as we know from the first scientific descriptions published in London in the midseventeenth century, muscle involvement consisting of weakness and generalized hypotonia is associated with bone involvement, its main characteristic. Therefore, since the discovery of vitamin D, it has been associated not only with bone health but also with muscle health 1 . Paradoxically, at present, there is no consensus on the potential beneficial effects of vitamin D supplementation on muscle function, balance and risk of falls, a situation highlighted in the last meta-analysis published by Bolland et al. 2 , who review in 81 randomized clinical trials (RCTs) that include 53,537 participants the effect of vitamin D on fractures and falls as a primary outcome. The pooled analyses showed that vitamin D supplementation had no effect on falls (37 RCTs, n=34,144, RR=0.97, 95% confidence interval -0.93 to 1.02), what the authors concluded that "vitamin D supplementation does not exert significant effects in falls", affirming that "potential future trials will probably not alter those conclusions, and that, therefore, there is little justification for the use of vitamin D supplements. to maintain or improve musculoskeletal health, indicating that clinical guidelines should reflect these findings" 2 . From this publication, many physicians and patients could mistakenly conclude that they can stop prescribing or taking vitamin D supplements, which is a potentially dangerous message, given the high prevalence of vitamin D deficiency in Spain 3 .Loss of muscle strength and/or function, severe invalidating myopathy predominantly proximal with diffuse muscular or skeletal pain in adults, generalized muscle atrophy and electromyographic abnormalities, such as polyphasic motor unit, potentials with shortened duration and decreased range, involvement of Type II muscle fiber atrophy (of rapid contraction) and marked fatty infiltration are findings in severe and sustained vitamin D deficiency, in severe renal insufficiency, or in the congenital absence of the CYP27B1 gene due to inability to adequately synthesize 1,25 dihydroxyvitamin D (1,25 DHCC), hormonally active metabolite of the endocrine system of vitamin D, with rapid improvement of muscle function after vitamin D or 1,25 DHC supplementation in these patients. More subtle changes in muscle function can be observed in subjects with less severe and perhaps less chronic vitamin D deficiency 4 .In our current issue, Gómez Alonso et al. 5 , present an article in which they observe that in patients of both sexes of the cohort EVOS (European Study of Vertebral Osteoporosis) that maintain serum levels of calcidiol higher than 20 ng/mL present greater grip strength in the hands, maintenance o...
El propósito de este artículo es presentar una revisión de la literatura acerca de la epidemiología, fisiopatología, manifestaciones clínicas y manejo de la osteomalacia. De este modo, se busca brindar información actualizada que conduzca a una mejor comprensión de la enfermedad y un adecuado tratamiento. Para una correcta mineralización ósea es necesario mantener un aporte adecuado de vitamina D y que los distintos procesos metabólicos que rigen sus efectos fisiológicos permanezcan indemnes, considerando que el papel de la vitamina D en el organismo es mantener la homeostasis del calcio y la salud ósea. El déficit de esta vitamina puede producir raquitismo durante la infancia y osteomalacia en adultos. El aporte de vitamina D al organismo puede darse por dos vías: de manera endógena, mediante la exposición de la piel a la luz solar; o de manera exógena, a partir de la dieta. Cualquier condición que produzca una alteración de las dos vías y genere un déficit significativo de vitamina D o de sus efectos fisiológicos puede manifestarse en los adultos como osteomalacia. En Colombia la deficiencia de vitamina D tiene una prevalencia de alrededor del 55,3 %. Las manifestaciones clínicas de la osteomalacia, considerando la amplia variedad de signos y síntomas, pueden denominarse conjuntamente como síndrome osteomalácico. Dadas las múltiples causas que pueden devenir en la osteomalacia, lo más adecuado es identificar la etiología que da origen al cuadro clínico para establecer un esquema terapéutico efectivo.
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