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

Indian Journal of Orthopaedics (2021)Cite this article

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.

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Affiliations

  1. Department of Orthopaedics, PGIMER, Chandigarh, 160012, India

    Karmesh Kumar, Himanshu Bhayana, Devendra Chouhan & Rajendra Kumar Kanojia

  2. Department of Histopathology, PGIMER, Chandigarh, 160012, India

    Kim Vaiphei

  3. Department of Endocrinology, PGIMER, Chandigarh, 160012, India

    Sanjay Bhadada

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  1. Karmesh Kumar
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  2. Himanshu Bhayana
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Correspondence to Rajendra Kumar Kanojia.

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Kumar, K., Bhayana, H., Vaiphei, K. et al. Coexistence of Osteomalacia in Osteoporotic Hip Fractures in More Than 50 Years Age Group. JOIO (2021). https://doi.org/10.1007/s43465-020-00323-z

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Keywords

  • Osteomalacia
  • Osteoporotic hip fracture
  • Vitamin D deficiency
  • Bone mineral density
  • Bone health