Neurosurgical Presentations of Osteomalacia: An Analysis of 100 Cases
Authors: Gumoriani Danyal Sadeeq , Bashir Kainat 
Published: July 2024

Abstract

Objectives: To assess the neurosurgical presentation of patients suffering from osteomalacia, a potentially preventable and treatable metabolic disease that can mimic neurological discogenic disorders.
Study Duration: May 2023 to November 2023, covering a period of 6 months in the Department of Neurosurgery, Qazi Hussain Ahmad Medical Complex, Nowshera.
Study Design: Descriptive observational study.
Methodology: This review study includes 100 cases of osteomalacia presenting as discogenic disorder, collected from the Neurosurgery OPD. Data were collected using a custom 1-page form, which included age, sex, marital status, pregnancy history, educational status, main presenting complaints, history of sunlight expo- sure in urban and rural settings,primary work and working condition, duration of symptoms, and history of medical and surgical treatments. Data were sup- plemented with hematological and biochemical profiles, including hemoglobin concentration, ESR, serum calcium, phosphate, and serum alkaline phosphatase levels. Detailed radiological findings, including Looser’s zones, and CT or MRI findings were recorded to exclude other conditions. Patients with biochemical profiles and radiological evidence of osteomalacia were included, while those with other conditions not meeting the criteria were excluded. The data were analyzed according to the set parameters and used for discussion and recommendations.
Results: Of the 100 patients diagnosed with osteomalacia, 57% were female and 43% were male. The age range was 14 to 50 years, with a mean age of 32 years. Educational status included 11% illiterate, 32% high school graduates, and 57% college graduates. 70% were from rural areas, and 30% were from urban locations. Among female patients, 47.37% were multiparous, 19.30% were non-multiparous, 15.79% had no children, and 17.54% were unmarried. Symptoms lasted 3 to 12 months, with a mean of 6 months. Significant past surgical history included spinal surgery in 7%, appendectomy in 5%, and C-section in 12%. Sunlight exposure was adequate in 70% and inadequate in 30%. Hemoglobin was less than 10 g/dL in 25% of cases, with normal levels in 75%. ESR was raised above 30 mm/hour in 33% of cases. Serum calcium was low in 73% and normal in 27%. Serum alkaline phosphatase was elevated above 3000 IU in 60.5% and markedly high in patients with fractures.
Conclusion: Our study highlights the significant prevalence of osteomalacia in neurosurgical patients, particularly among females, rural residents, and those with lower educational levels. This underscores the need for improved primary healthcare systems and timely referrals. In neurosurgical settings, osteomalacia often presents a diagnostic challenge, as its symptoms can mimic various spinal and neurological disorders. This underscores the importance of maintaining a high index of suspicion and conducting thorough metabolic evaluations in patients presenting with chronic musculoskeletal pain. Diagnostic indicators include low hemoglobin, raised ESR, subnormal serum calcium, and radiological changes. Increased awareness and screening for osteomalacia in patients with gastroin- testinal disorders and renal issues are recommended to prevent misdiagnosis and ensure timely treatment.