Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan 15;55(3):614-620.
doi: 10.1007/s43465-020-00323-z. eCollection 2021 Jun.

Coexistence of Osteomalacia in Osteoporotic Hip Fractures in More Than 50 Years Age Group

Karmesh Kumar  1 , Himanshu Bhayana  1 , Kim Vaiphei  2 , Devendra Chouhan  1 , Rajendra Kumar Kanojia  1 , Sanjay Bhadada  3
Affiliations

Coexistence of Osteomalacia in Osteoporotic Hip Fractures in More Than 50 Years Age Group

Karmesh Kumar et al. Indian J Orthop. .

Abstract

Introduction: Osteomalacia is a hitherto common orthopaedic condition and is commonly coexists with osteoporosis. However, the identification of osteomalacia always slips under the radar and more emphasis is given to diagnosis and management of osteoporosis. Identification of osteomalacia is equally relevant as management of the osteoporotic fractures is different with or without osteomalacia.

Methods: This was a prospective study design that included patients 50 years or above of either sex presented with proximal femur fractures. Osteoporosis was identified by DEXA scan of hip and lumbar spine. Metabolic tests including serum calcium, phosphorus, ALP and vitamin D levels were done. Histopathological diagnosis of osteomalacia was performed on bony tissues that were taken during surgery from a site adjacent to the fracture and histological examination was performed on non-decalcified paraffin sections using special stains.

Results: A total of 45 patients was included in study. Mean age was 68.7 years (53-85 years). Abnormal values of serum calcium, phosphorus, ALP, vitamin D were noted in 44.4%, 22.2%, 53.3% and 48.9% patients, respectively. On histopathology, 73.17% patients showed osteomalacia. No significant correlation was found between serum biochemical markers and histopathology except with serum Vitamin D (p value - 0.004).

Conclusion: The majority of patients with osteoporotic hip fractures had coexisting osteomalacia. Abnormal biochemical values were not significantly associated with osteomalacia. Hence, histopathology remains the gold standard for the diagnosis of osteomalacia. Further research is needed to identify a biomarker that may enable the clinician to diagnosis and treat osteomalacia well in time.

Keywords: Bone health; Bone mineral density; Osteomalacia; Osteoporotic hip fracture; Vitamin D deficiency.

PubMed Disclaimer

Conflict of interest statement

Conflict of interestThe authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
The following photomicrographs of bone morphologies shown in Haematoxylin and eosin (a), Elastic Van Gieson (b), Masson’ trichrome (c) and Solochrome cyanine (d) staining
Fig. 2
Fig. 2
Correlation between serum vitamin D values and histopathology grading (1—Normal, 2—mild, 3—moderate and severe)
See this image and copyright information in PMC

References

    1. Parfitt AM. Osteomalacia and related disorders. In: Avioli VL, Krane SM, editors. Metabolic Bone Disease and Clinically Related Disorders. 3. New York: Academic Press; 1996. pp. 327–386.
    1. Holick MF. Vitamin D deficiency. New England Journal of Medicine. 2007;357:266–281. doi: 10.1056/NEJMra070553. - DOI - PubMed
    1. Rao DS. Role of vitamin D and calcium nutrition in bone health in India. In: Mithal A, Rao DS, Zaidi M, editors. Metabolic Bone Disorders. Lucknow: Hindustani Book Depot; 1998. pp. 71–75.
    1. Malhotra N, Mithal A. Osteoporosis in Indians. Indian Journal of Medical Research. 2008;127:263–268. - PubMed
    1. Goswami R, Gupta N, Goswami D, Marwaha RK, Tandon N, Kochupillai N. Prevalence and significance of low 25 hydroxyvitamin D concentrations in healthy subjects in Delhi. American Journal of Clinical Nutrition. 2000;72:472–475. doi: 10.1093/ajcn/72.2.472. - DOI - PubMed

LinkOut - more resources