Prevalence of biochemical osteomalacia in adults undergoing vitamin D testing

Mark J Bolland; Alison Avenell; Andrew Grey

doi:10.1111/cen.14483

Prevalence of biochemical osteomalacia in adults undergoing vitamin D testing

Mark J Bolland^* (Corresponding Author), Alison Avenell, Andrew Grey

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

5 Citations (Scopus)

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Abstract

Objective

Prolonged severe vitamin D deficiency can cause osteomalacia, but the 25‐hydroxyvitamin D (25OHD) concentration below which this occurs is unknown. We investigated the prevalence of biochemical osteomalacia in adults with a measurement of 25OHD.

Design, Measurement, and Patients

25OHD results between 1/1/2009 and 15/6/2020 were obtained from the regional laboratory database, together with measurements of serum calcium, parathyroid hormone (PTH) and alkaline phosphatase (ALP) within 6 months of the index 25OHD. We defined biochemical osteomalacia as all 3 of: albumin‐adjusted serum calcium (aCa)<2.0 mmol/L, PTH>7.3 pmol/L and ALP>150 IU/L. Possible osteomalacia was 2/3 criteria with the other test not done. 25OHD measurements associated with significant renal impairment, elevated hepatic transaminases or hypercalcaemia were excluded.

Results

110,046 25OHD measurements were identified over the 11.5 years period. After removal of ineligible measurements, 42,171 25OHD measurements from 32,386 individuals with at least 2 of aCa, PTH and ALP were included in analyses. Median 25OHD was 63 nmol/L; 8% were <25 nmol/L, and 33% were <50 nmol/L. Five index 25OHD measurements met the definition of biochemical osteomalacia, and another 11 were possible osteomalacia. After reviewing available clinical records for these 16 episodes, we classified 9 cases as osteomalacia and 7 as other diagnoses. Thus, the prevalence of biochemical osteomalacia was 0.02% (9/42,171) for 25OHD measurements and 0.23% (8/3432) for 25OHD<25 nmol/L. All cases of osteomalacia with 25OHD measurements prior to supplementation had 25OHD≤18 nmol/L.

Conclusion

The prevalence of biochemical osteomalacia is very low, even in individuals with 25OHD<25 nmol/L.

Original language	English
Pages (from-to)	74-83
Number of pages	10
Journal	Clinical Endocrinology
Volume	95
Issue number	1
Early online date	25 Apr 2021
DOIs	https://doi.org/10.1111/cen.14483
Publication status	Published - Jul 2021

Bibliographical note

Acknowledgements
We thank Josh Newmark, NHS Grampian, for discussions on cut-offs for renal
function tests.
Funding:
This study was funded by the Health Research Council of New Zealand.

Keywords

Deficiency
hypocalcaemia
insufficiency
osteomalacia
vitamin D

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This is the peer reviewed version of the following article: Bolland, MJ, Avenell, A, Grey, A. Prevalence of biochemical osteomalacia in adults undergoing vitamin D testing. Clin Endocrinol (Oxf). 2021; 00: 1– 10. https://doi.org/10.1111/cen.14483, which has been published in final form at https://onlinelibrary.wiley.com/doi/full/10.1111/cen.14483. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Accepted author manuscript, 1.2 MBLicence: Unspecified

Cite this

@article{3b24e7e9d2774274837c3e84fb803339,

title = "Prevalence of biochemical osteomalacia in adults undergoing vitamin D testing",

abstract = "ObjectiveProlonged severe vitamin D deficiency can cause osteomalacia, but the 25‐hydroxyvitamin D (25OHD) concentration below which this occurs is unknown. We investigated the prevalence of biochemical osteomalacia in adults with a measurement of 25OHD.Design, Measurement, and Patients25OHD results between 1/1/2009 and 15/6/2020 were obtained from the regional laboratory database, together with measurements of serum calcium, parathyroid hormone (PTH) and alkaline phosphatase (ALP) within 6 months of the index 25OHD. We defined biochemical osteomalacia as all 3 of: albumin‐adjusted serum calcium (aCa)<2.0 mmol/L, PTH>7.3 pmol/L and ALP>150 IU/L. Possible osteomalacia was 2/3 criteria with the other test not done. 25OHD measurements associated with significant renal impairment, elevated hepatic transaminases or hypercalcaemia were excluded.Results110,046 25OHD measurements were identified over the 11.5 years period. After removal of ineligible measurements, 42,171 25OHD measurements from 32,386 individuals with at least 2 of aCa, PTH and ALP were included in analyses. Median 25OHD was 63 nmol/L; 8% were <25 nmol/L, and 33% were <50 nmol/L. Five index 25OHD measurements met the definition of biochemical osteomalacia, and another 11 were possible osteomalacia. After reviewing available clinical records for these 16 episodes, we classified 9 cases as osteomalacia and 7 as other diagnoses. Thus, the prevalence of biochemical osteomalacia was 0.02% (9/42,171) for 25OHD measurements and 0.23% (8/3432) for 25OHD<25 nmol/L. All cases of osteomalacia with 25OHD measurements prior to supplementation had 25OHD≤18 nmol/L.ConclusionThe prevalence of biochemical osteomalacia is very low, even in individuals with 25OHD<25 nmol/L.",

keywords = "Deficiency, hypocalcaemia, insufficiency, osteomalacia, vitamin D",

author = "Bolland, {Mark J} and Alison Avenell and Andrew Grey",

note = "Acknowledgements We thank Josh Newmark, NHS Grampian, for discussions on cut-offs for renal function tests. Funding: This study was funded by the Health Research Council of New Zealand. ",

year = "2021",

month = jul,

doi = "10.1111/cen.14483",

language = "English",

volume = "95",

pages = "74--83",

journal = "Clinical Endocrinology",

issn = "0300-0664",

publisher = "Wiley-Blackwell",

number = "1",

}

TY - JOUR

T1 - Prevalence of biochemical osteomalacia in adults undergoing vitamin D testing

AU - Bolland, Mark J

AU - Avenell, Alison

AU - Grey, Andrew

N1 - Acknowledgements We thank Josh Newmark, NHS Grampian, for discussions on cut-offs for renal function tests. Funding: This study was funded by the Health Research Council of New Zealand.

PY - 2021/7

Y1 - 2021/7

N2 - ObjectiveProlonged severe vitamin D deficiency can cause osteomalacia, but the 25‐hydroxyvitamin D (25OHD) concentration below which this occurs is unknown. We investigated the prevalence of biochemical osteomalacia in adults with a measurement of 25OHD.Design, Measurement, and Patients25OHD results between 1/1/2009 and 15/6/2020 were obtained from the regional laboratory database, together with measurements of serum calcium, parathyroid hormone (PTH) and alkaline phosphatase (ALP) within 6 months of the index 25OHD. We defined biochemical osteomalacia as all 3 of: albumin‐adjusted serum calcium (aCa)<2.0 mmol/L, PTH>7.3 pmol/L and ALP>150 IU/L. Possible osteomalacia was 2/3 criteria with the other test not done. 25OHD measurements associated with significant renal impairment, elevated hepatic transaminases or hypercalcaemia were excluded.Results110,046 25OHD measurements were identified over the 11.5 years period. After removal of ineligible measurements, 42,171 25OHD measurements from 32,386 individuals with at least 2 of aCa, PTH and ALP were included in analyses. Median 25OHD was 63 nmol/L; 8% were <25 nmol/L, and 33% were <50 nmol/L. Five index 25OHD measurements met the definition of biochemical osteomalacia, and another 11 were possible osteomalacia. After reviewing available clinical records for these 16 episodes, we classified 9 cases as osteomalacia and 7 as other diagnoses. Thus, the prevalence of biochemical osteomalacia was 0.02% (9/42,171) for 25OHD measurements and 0.23% (8/3432) for 25OHD<25 nmol/L. All cases of osteomalacia with 25OHD measurements prior to supplementation had 25OHD≤18 nmol/L.ConclusionThe prevalence of biochemical osteomalacia is very low, even in individuals with 25OHD<25 nmol/L.

AB - ObjectiveProlonged severe vitamin D deficiency can cause osteomalacia, but the 25‐hydroxyvitamin D (25OHD) concentration below which this occurs is unknown. We investigated the prevalence of biochemical osteomalacia in adults with a measurement of 25OHD.Design, Measurement, and Patients25OHD results between 1/1/2009 and 15/6/2020 were obtained from the regional laboratory database, together with measurements of serum calcium, parathyroid hormone (PTH) and alkaline phosphatase (ALP) within 6 months of the index 25OHD. We defined biochemical osteomalacia as all 3 of: albumin‐adjusted serum calcium (aCa)<2.0 mmol/L, PTH>7.3 pmol/L and ALP>150 IU/L. Possible osteomalacia was 2/3 criteria with the other test not done. 25OHD measurements associated with significant renal impairment, elevated hepatic transaminases or hypercalcaemia were excluded.Results110,046 25OHD measurements were identified over the 11.5 years period. After removal of ineligible measurements, 42,171 25OHD measurements from 32,386 individuals with at least 2 of aCa, PTH and ALP were included in analyses. Median 25OHD was 63 nmol/L; 8% were <25 nmol/L, and 33% were <50 nmol/L. Five index 25OHD measurements met the definition of biochemical osteomalacia, and another 11 were possible osteomalacia. After reviewing available clinical records for these 16 episodes, we classified 9 cases as osteomalacia and 7 as other diagnoses. Thus, the prevalence of biochemical osteomalacia was 0.02% (9/42,171) for 25OHD measurements and 0.23% (8/3432) for 25OHD<25 nmol/L. All cases of osteomalacia with 25OHD measurements prior to supplementation had 25OHD≤18 nmol/L.ConclusionThe prevalence of biochemical osteomalacia is very low, even in individuals with 25OHD<25 nmol/L.

KW - Deficiency

KW - hypocalcaemia

KW - insufficiency

KW - osteomalacia

KW - vitamin D

U2 - 10.1111/cen.14483

DO - 10.1111/cen.14483

M3 - Article

C2 - 33866594

SN - 0300-0664

VL - 95

SP - 74

EP - 83

JO - Clinical Endocrinology

JF - Clinical Endocrinology

IS - 1

ER -

Prevalence of biochemical osteomalacia in adults undergoing vitamin D testing

Abstract

Bibliographical note

Keywords

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