Proximal weakness of the muscles of the shoulders and of the hips (proximal myopathy) may be the first sign of osteomalacia and can lead to a misdiagnosis of muscle disease instead of metabolic disease (vitamin D deficiency).
For example, two cases of proximal myopathy are presented in people of South Asian origin and who are lacto-vegetarians (don’t eat animal products and don’t drink milk.) They are a 31-year old Indian man and a 34-year old Indian woman. Both patients were living in Ireland at the time of the study, and had waddling gaits, with low 25-hydroxyvitamin D levels, low serum calciums and high parathyroid hormone (PTH) levels. Importunately, both improved with high doses of vitamin D and calcium.
In these two cases, symptoms disappeared after the patients were placed on vitamin D and calcium supplement therapy. They were deficient of vitamin D from lack of sunlight and from lack of dietary vitamin D. They ate unleavened bread (chapati) daily. Unfortunately, unleavened bread contains phytic acid which reduces mineral absorption (including calcium absorption). High PTH levels are known to be neurotoxic. Treatment of these two patients gave them almost immediate clinical recovery.
CONCLUSION: Diagnosis is very important in cases of muscle weakness, since the symptoms of muscle weakness with osteomalacia are easily reversible with vitamin D and calcium pills.
NOTE: Read about vitamin D, youths and diabetes.
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