ALKALINE PHOSPHATASE AS A SCREENING TEST FOR OSTEOMALACIA

Muhammad Amin Chinoy, Muhammad Imran Javed, Alamzeb Khan, Nooruddin Sadruddin

Abstract


Background: Vitamin D deficiency remains common in children and adults in Pakistan despite
adequate sunlight exposure. Diagnosis in adults is usually delayed and is made following pathological
fractures that result in significant morbidity. The objective of this study was to see whether Serum
Alkaline Phosphatase levels could be used as a screening test for osteomalacia. Methods: The Study
was conducted at Fatima Hospital, Baqai Medical University, Gadap, Karachi, between July 2002 and
June 2005. Serum calcium levels are commonly used to screen patients suspected of osteomalacia, and
raised serum alkaline phosphatase (SALP) is considered a diagnostic finding. We used SALP to screen
patients who presented with back or non-specific aches and pain of more than six months duration.
Results: Three hundred thirty-four (334) patients were screened of which 116 (35%) had raised SALP.
Osteomalacia was diagnosed in 92 (79.3%) of these 116 either by plain radiographs, bone biopsy or
isotope bone scan. Fifty-four (53.4%) of the 101 cases had a normal level of serum calcium.
Conclusions: Osteomalacia is likely to be missed if only serum calcium is used to screen patients.
Serum Alkaline Phosphate should be used as the preferred method for screening these patients.
Keywords: Osteomalacia, Metabolic bone disease, Serum Alkaline Phosphatase (SALP), Screening

Full Text:

PDF

References


Sahibzada AS, Khan MS, Javed M; Presentation of osteomalacia in

Kohistani women. J Ayub Med Coll Abbottabad 2004;16(3):63–5.

Goswami R, Gupta N, Goswami D, Marwaha RK, Tandon N,

Kochupillai N. Prevalence and significance of low 25-

hydroxyvitamin D concentrations in healthy subjects in Delhi. Am

J Clin Nutr 2000;72:472–5.

Al Faraj S, Al Mutairi K. Vitamin D deficiency and chronic low

back pain in Saudi Arabia. Spine 2003;28(2):177–9.

Riaz S, Alam M, Umer M. Frequency of osteomalacia in elderly

patients with hip fractures. J Pak Med Assoc 2006;56:273–6.

El-Desouki MI, Othman SM, Fouda MA. Bone mineral density

and bone scintigraphy in adult Saudi female patients with

Osteomalacia. Saudi Med J 2004;25:355–8.

Al-Jurayyan NA, El-Desouki ME, Al-Herbish AS, Al-Mazyad AS,

Al-Qhtani MM. Nutritional rickets and osteomalacia in school

children and adolescents. Saudi Med J 2002;23:182–5.

El-Sonbaty MR, Abdul-Ghaffar NU. Vitamin D deficiency in

veiled Kuwaiti women. Eur J Clin Nutr 1996;50:315–8.

Guzel R, Kozanoglu E, Guler-Uysal F, Soyupak S, Sarpel T.

Vitamin D status and bone mineral density of veiled and unveiled

Turkish women. J Women’s Health Gend Based Med

;10:765–70.

Gullu S, Erdogan MF, Uysal AR, Baskal N, Kamel AN, Erdogan

G. A potential risk for osteomalacia due to sociocultural lifestyle in

Turkish women. Endocr J 1998;45:675–8.

Solanki T, Hyatt RH, Kemm JR, Hughes EA, Cowan RA. Are

elderly Asians in Britain at a high risk of vitamin D deficiency and

osteomalacia? Age Ageing 1995;24(2):103–7.

Sachan A, Gupta R, Das V, Agarwal A, Awasthi PK, Bhatia V.

High prevalence of vitamin D deficiency among pregnant women

and their newborns in northern India. Am J Clin Nutr

;81:1060–4.

Brunvand L, Shah SS, Bergstrom S, Haug E. Vitamin D deficiency

in pregnancy is not associated with obstructed labor. A study

among Pakistani women in Karachi. Acta Obstet Gynecol Scand

;77(3):303–6.

Armas LA, Dowell S, Akhter M, Duthuluru S, Huerter C, Hollis

BW, et al. Ultraviolet-B radiation increases serum 25-hydroxy

vitamin D levels: the effect of UVB dose and skin color. J Am

Acad Dermatol 2007;57(4):588–93.

Turnbull DJ, Parisi AV, Kimlin MG. Vitamin D effective

ultraviolet wavelengths due to scattering in shade. J Steroid

Biochem Mol Biol 2005;96:431–6.

Ogunkolade WB, Boucher BJ, Bustin SA, Burrin JM, Noonan K,

Mannan N, et al. Vitamin D metabolism in peripheral blood

Mononuclear cells is influenced by chewing ‘Betel Nut’ (Areca

catechu) and Vitamin D status. J Clin Endocrinol Metab

;91:2612–7.

Glerup H, Mikkelsen K, Poulsen L, Hass E, Overbeck S, Andersen

H, Charles P, et al. Hypovitaminosis D myopathy without

biochemical signs of osteomalacic bone involvement. Calcif Tissue

Int 2000;66:419–24.

Chadha M, Balain B, Maini L, Dhal A. Spontaneous bilateral

displaced femoral neck fractures in nutritional osteomalacia--a case

report. Acta Orthop Scand 2001;72(1):94–6.

Peacey SR. Routine biochemistry in suspected vitamin D

deficiency. J R Soc Med 2004;97:322–5.


Refbacks

  • There are currently no refbacks.


Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]