Vitamin D Deficiency and Pseudofractures in Child-Bearing Egyptian Women: Successful Medical Treatment Helps to Avoid Fractures and Surgical Interference

Abstract

Background: Recent evidence for the effects of vitamin D and recognition of the high prevalence of its deficiency has increased the interest in it. Vitamin D-sub nutrition may contribute to the risk of a wide range of disorders. Methods: The females in the child-bearing period attending the endocrinology and orthopedic out-patient clinics complaining of pain and/or tenderness at the groin were evaluated. Patients with chronic metabolic or skeletal illness, primary hyperparathyroidism, and patients receiving drugs that interfere with bone mineral metabolisms were excluded. One hundred accepted and consented to participation in the study. All the participants were subjected to full history taking, clinical evaluation, laboratory investigations including serum Ca, Ph, PTH, ALP, TSH, F T4, F T3, Cortisol level, and 25(OH)D level. Plain X-ray was done for the regions of bony tenderness. The subjects were divided into 2 groups based on the presence or absence of pseudo-fractures (looser zones). They were treated and followed up till normalization of the laboratory parameters and healing of the looser zones. Results: The mean age for patients was 30.45 ± 5.8, their mean 25(OH) vitamin D level was 14.7 ± 5.9 ng/ml, the mean PTH was 195.7 ± 162.6, and looser zones were evident in the X-rays of 34 patients. The serum 25(OH)D showed significant negative correlations with veiling, parity, localized hip pain, and tenderness, ALP, PTH, but, a significant positive correlation with sun exposure, dairy products consumption, vitamin D supplementation, and serum calcium levels. The independent factors associated with hypovitaminosis D were the lack of sun exposure, lack of vitamin D supplementation, and the presence of pseudo- fracture (p ≤ 0.009, 0.038, and 0.001 respectively). No surgery was required in any of our patients. Conclusions: Vitamin D deficiency is common in our region. The main risk factors are decreased sun exposure, low dairy products consumption, and lack of vitamin D supplementation. Successful medical treatment may be helpful to satisfy the patient, avoid true fracture and further major surgical treatments.