Concealing Clothing Leading to Severe Vitamin D Deficiency, Osteomalacia and Muscle Weakness

Abstract

BACKGROUND: Vitamin D deficiency is the most common nutritional deficiency worldwide in all ages. Prolonged and severe vitamin D deficiency can result in secondary hyperparathyroidism and osteomalacia. Vitamin D deficiency can be caused by various factors included here institutionalisation, malabsorption, inadequate exposure to sunlight etc. Osteomalacia is a disorder of decreased mineralisation of newly formed osteoid at sited of bone turnover, which can be manifested with symptoms such as diffuse body aches and pain. Muscles weakness from vitamin D deficiency causes difficulty in walking, developing proximal myopathy. Nearly 30-50% of all age groups are Vitamin D deficient worldwide.
 CASE PRESENTATION: We report a case of 51-years-old woman, with a religious garment, with slowly progressing weakness of the proximal limb muscles, extreme fatigue, chest and lower spine pain, paresthesia, depression, difficulties in walking and waddling gait. On whole-body bone scintigraphy diffuse metabolic changes were present, and in DXA osteoporosis was shown due to severe vitamin D deficiency and secondary hyperparathyroidism. Treatment with high doses of vitamin D and calcium replacement improved clinical manifestation of osteomalacia for few months. Absent of waddling gait with no pain was evident due to the better muscle and bone performance after the treatment.
 CONCLUSION: Suspicious cases for osteomalacia in population wearing a religious garment and those that are not adequately exposed to the sunlight, laboratory evaluation should include measurement of 25 (OH) vitamin D, PTH, calcium, alkaline phosphatase and performing of DXA in order such cases do not get undiagnosed.

Atypical osteomalacia mimicking radiological features of spondyloarthritis: Never judge a book by its cover

“…Osteomalacia (OM) is a metabolic bone disorder characterized by decreased mineralization of the bone matrix. 1 It can manifest with symptoms such as diffuse bone pain, muscular weakness, difficulty in walking, and restriction of spinal mobility and polyarthralgia. Because these symptoms are common, the diagnosis of OM may easily be missed or confused with several other conditions, such as spondyloarthritis (SpA), polymyalgia rheumatica, polymyositis, fibromyalgia, diffuse idiopathic skeletal hyperostosis, thyroid disease, overuse, metastatic bone disease, multiple myeloma, and osteoporosis.…”

“…Osteomalacia (OM) is a metabolic bone disorder characterized by decreased mineralization of the bone matrix 1 . It can manifest with symptoms such as diffuse bone pain, muscular weakness, difficulty in walking, and restriction of spinal mobility and polyarthralgia.…”

Bone Deformity due to Rickets and Osteomalacia in Children and Adolescents

“…Osteomalacia is a major metabolic bone disease that results from a chronic and severe deficiency of vitamin D or phosphate from any cause after growth has stopped. A deficiency of vitamin D or phosphate leads to defective bone mineralization and generalized or localized vague bone pain in various parts of the skeleton and / or proximal muscle weakness [4]. Osteomalacia is more common in regions where sun exposure is low due to long winters with early sunsets or wearing traditional long clothing.…”