Osteomalacic Myopathy and Early Gait Changes

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