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Severe Proximal Myopathy with Remarkable Recovery after Vitamin D Treatment

Published online by Cambridge University Press:  02 December 2014

Yousef A. Al-Said ,
Hiyam S. Al-Rached ,
Hussien A. Al-Qahtani  and
Mohammed M.S. Jan
Yousef A. Al-Said
Affiliation:
Department of Neurosciences, King Faisal Specialist Hospital & Research Center
Hiyam S. Al-Rached
Affiliation:
Department of Neurosciences, King Faisal Specialist Hospital & Research Center
Hussien A. Al-Qahtani
Affiliation:
Department of Internal Medicine, King Abdulaziz Medical City
Mohammed M.S. Jan*
Affiliation:
Department of Neurosciences, King Faisal Specialist Hospital & Research Center Department of Pediatrics, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
*
Pediatric Neurology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center, MBC J-76, PO Box 40047, Jeddah 21499, Kingdom of Saudi Arabia
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Abstract

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Background:

Osteomalacia is an uncommon cause of muscle weakness. Our objectives were to describe features of myopathy associated with Vitamin D deficiency and examine the contributing factors leading to osteomalacic myopathy in our region.

Methods:

Patients identified retrospectively for the six year period ending in December 2006 with the diagnosis of osteomalacia and/or Vitamin D deficiency associated proximal muscle weakness were included. They were followed in three major centers in western Saudi Arabia. Clinical, biochemical, radiological, and electrophysiological findings were collected before and after Vitamin D treatment by chart review.

Results:

Forty seven female patients aged 13-46 years (mean 23.5, SD 4.5) were included. All were veiled and covered heavily when outside the house for social and cultural reasons. Only eight (17%) had adequate varied diet with daily milk ingestion. All patients presented with progressive proximal muscle weakness lasting 6-24 months (mean 14) prior to our evaluation. The weakness was severe in six (13%) patients leading to wheel chair bound states. Associated musculoskeletal pain involving the back, hips, or lower limbs was common (66%). Osteomalcia was the referral diagnosis in only 11 patients and the remaining 36 (77%) patients were misdiagnosed. All patients had metabolic and radiological profiles suggestive of osteomalacia. Remarkable recovery was documented in all patients following oral cholecalciferol and calcium supplementation.

Conclusions:

Vitamin D deficiency is an important treatable cause of osteomalacic myopathy in Saudi Arabia. The diagnosis is frequently delayed or missed. Screening for Vitamin D deficiency in patients with acquired myopathy is needed to identify this treatable disorder.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 36 , Issue 3 , May 2009 , pp. 336 - 339
Copyright
Copyright © The Canadian Journal of Neurological 2009

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