Aetiology and clinical profile of osteomalacia in adolescent girls in northern India.
BACKGROUND
The adolescent age group is particularly prone to nutritional rickets/osteomalacia due to an increased demand for nutrients, especially calcium and vitamin D. Osteomalacia presents with non-specific signs and symptoms because of which diagnosis may be delayed. Vitamin D deficiency is unexpected in India, which is a tropical country with abundant sunshine.


METHODS
We prospectively studied the clinical presentation, aetiology and social factors contributing to adolescent rickets/ osteomalacia in our region.


RESULTS
We saw 21 symptomatic adolescents with osteomalacia during the study period (November 2000-July 2002). All were girls. Only 1 practised purda and 4 belonged to a low socioeconomic class. The mean (SD) duration of illness before correct diagnosis was 2.8 (2.1) years. Bone pains and muscular weakness were universally present. Non-specific complaints (especially limb pains being mistaken for joint involvement) led to a delay in diagnosis with consequent morbidity. All but 1 patient had low serum 25-hydroxyvitamin D levels (<10 ng/ml), with the mean (SD) being 4.9 (2.7) ng/ml. Their mean dietary calcium intake was low 1265 (199) mg/day, range 40-810 mg/day]. Restricted outdoor activities (n = 19) and the traditional dress code (n = 21) were contributory factors, as they led to poor exposure to sunshine.


CONCLUSIONS
Nutritional osteomalacia among adolescents is a poorly recognized entity. Even in non-purda practising communities in the tropics, poor exposure to sunshine due to social factors, compounded by low dietary calcium intake, can lead to osteomalacia in adolescents.
Rajeswari
J
J
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India.
Balasubramanian
K
K
Bhatia
V
V
Sharma
V P
VP
Agarwal
A K
AK
D000293:Adolescent; D002118:Calcium / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D010018:Osteomalacia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D011859:Radiography; D012307:Risk Factors; D013472:Sunlight; D014808:Vitamin D Deficiency / Q000453:epidemiology
D002118:Calcium