Validation of the Clinical, Radiological, Biochemical Parameters of Osteomalacia

Background: Osteomalacia, a metabolic bone disorder characterized by softening of the bones caused by defective bone mineralization secondary to inadequate amounts of available phosphorus and calcium, or because of overactive resorption of calcium from the bone as a result of hyperparathyroidism. The diagnosis of Osteomalacia is dependent on clinical, radiographic and biochemical parameters still, none of these are pathognomonic of the disorder, and histologic examination of a bone biopsy, an invasive procedure is usually necessary to confirm the diagnosis. We used diagnostic criteria based on clinical, biochemical and radiological parameters to diagnose Osteomalacia with adequate accuracy. Methodology: This was Cross sectional and observational study. A total of 100 patients age between 18-65 years attending OPD with complaints of persistent, non-specific and generalized musculoskeletal pain were included in the study. Thorough history was taken and examination was done. They were subjected to biochemical investigation including haemogram, serum vitamin D, serum calcium, serum phosphorus, serum alkaline phosphates, serum PTH and radiological investigation including X-ray: Pelvis with both hips, x-ray lumbosacral spine. We used scoring criteria including pain score and Diet criteria and diagnostic index of [1] for diagnosing Osteomalacia. Data received from biochemical test was analyzed and correlated with the clinical findings. Results: We observed that only generalized pain at presentation and vitamin D level of <19.23ng/ml was significantly associated with outcome. On evaluating the combination of presence of these criteria we observed it to be 75% sensitive and 93.8% specific with a PPV of 75% and NPV of 93.8% and an accuracy of 68.8%. Conclusion: Modified two component criteria can be used as for assessment, however, its efficacy against biopsy proven cases of Osteomalacia needs further evaluation apart from its validation in different population groups.