Osteomalacic Myopathy and Early Gait Changes

<p>Background: The incidence and prevalence of osteomalacia are vastly underestimated<br>for at‐risk populations. Increased awareness and knowledge of the disease are essential<br>for its early diagnosis and prompt treatment.<br>Aim: This study aimed to establish proximal myopathy, gait abnormalities, and history<br>of pica as early presenting symptoms of osteomalacia in young women, as well as<br>complete remission of these symptoms on adequate supplementation.<br>Materials and Methods: This prospective study included 36 young women (18–32<br>years of age) clinically suspected and diagnosed with osteomalacia using the UdayHogler criteria and radiological features from December 2022 to December 2023.<br>Baseline Harris Hip Score, visual analogue scale pain score, and power at hip extensors<br>were also recorded. Subjects were treated with weekly vitamin D, and daily calcium<br>and micronutrient supplementation. Adequate sun exposure was advised. Patients were<br>followed up at four, 12, and 24 weeks post-initiation of treatment. Improvements in<br>Harris Hip Score, visual analogue scale pain score, and power at hip extensor muscles<br>were noted, and comparisons were made to establish statistical significance. Serum<br>calcidiol, alkaline phosphatase, parathormone, and urine calcium levels were also<br>monitored.<br>Results: Of those diagnosed with osteomalacia, 26 (72%) and 23 (63.8%) presented<br>with symptoms of proximal myopathy with early gait changes, and history of pica,<br>respectively; both conditions were reversible on adequate supplementation with<br>vitamin D and calcium (p=0.001). On follow-up, patients demonstrated improvement in<br>gait, muscle power, and ability to climb up stairs and get up from the ground over a<br>period of 4–24 weeks. Statistical analysis showed significant improvement in all the<br>parameters under study. Hematological studies showed gradual improvement towards<br>normal ranges.<br>Conclusion: Osteomalacia should be considered as a differential diagnosis in young<br>women with diffuse muscle and bone pain, early proximal muscle weakness, altered<br>gait pattern, and history of pica, and the underlying disease should be investigated.</p>