ALKALINE PHOSPHATASE AS A SCREENING TEST FOR OSTEOMALACIA
AbstractBackground: Vitamin D deficiency remains common in children and adults in Pakistan despiteadequate sunlight exposure. Diagnosis in adults is usually delayed and is made following pathologicalfractures that result in significant morbidity. The objective of this study was to see whether SerumAlkaline Phosphatase levels could be used as a screening test for osteomalacia. Methods: The Studywas conducted at Fatima Hospital, Baqai Medical University, Gadap, Karachi, between July 2002 andJune 2005. Serum calcium levels are commonly used to screen patients suspected of osteomalacia, andraised serum alkaline phosphatase (SALP) is considered a diagnostic finding. We used SALP to screenpatients 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 orisotope 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
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
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
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
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
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
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.