![]() ![]() Osteomalacia is a metabolic and systemic skeletal disorder in children and adults with impaired mineralization of pre-formed bone matrix, alongside malaise, pain, and muscle weakness. While these strategies have led to modest success in terms of improving the vitamin D status of the community over time, several populations, children and adolescents, in particular, remain vulnerable to the complications of vitamin D deficiency, including nutritional rickets and osteomalacia, disorders that are likely underdiagnosed and relatively understudied in the Middle East region. Given the pivotal role of vitamin D in bone and calcium metabolism, aggressive public health campaigns, including several local and regional guidelines, were released to address this high prevalence of vitamin D deficiency within the Arabic community. However, this prevalence jumps to 81% when other population groups, such as newborns, children, and adolescents, as well as pregnant and lactating women are included. In Saudi Arabia, the overall prevalence of low vitamin D (defined as 25OHD < 50nmol/L) in adults was 63.5%, based on a recent meta-analysis involving 16 epidemiological studies. This is not surprising given that dietary sources of vitamin D are very few unless food is fortified with vitamin D and, therefore, humans rely on sunlight to synthesize vitamin D. ![]() Insufficient dietary vitamin D intake (below the estimated average requirement of 10 μg/day) exists within populations around the globe, further exacerbating the vitamin D deficiency pandemic. The global prevalence of vitamin D deficiency and insufficiency (defined as serum 25 hydroxyvitamin D < 30 and 30–50 nmol/L) ranges from ~5–18% to 24–49%, respectively, depending on the study region and population. The proposed combination of typically altered mineralization markers for the diagnosis of osteomalacia is, at best, suggestive until further comparisons with established diagnostic tools (histological analysis of bone biopsies) are conducted. Screening of apparently healthy Arab adolescents revealed a high prevalence of deranged mineralization markers suggestive of biochemical osteomalacia, which was significantly more common in girls than boys and was likely associated with Arab traditional clothing and diet. Overall, girls were 4.6 times (95% CI 3.3–6.4) more likely to have biochemical osteomalacia than boys. The prevalence of low serum Ca and/or Pi was also higher in girls than in boys (24.2% vs. ![]() The overall prevalence of biochemical osteomalacia was 10.0% (n = 295/2938) and was higher in girls than boys (14.7% vs. Vitamin D deficiency was noted in 56.2% (n = 953) of girls and 27.1% (n = 336) of boys ( p < 0.001). A total of 2938 Arab adolescents were recruited. Biochemical osteomalacia was defined as any two of the following four serum markers of hypomineralization, namely low 25 hydroxyvitamin D (25OHD < 30 nmol/L), high alkaline phosphatase (ALP), low calcium (Ca), and/or inorganic phosphorous (Pi). Anthropometrics and fasting blood samples were collected. In this cross-sectional study performed between September 2019 and March 2021, adolescents aged 12–17 years from 60 different secondary and preparatory year schools in Riyadh, Saudi Arabia were included. This study assessed the prevalence of biochemical osteomalacia in Arab adolescents. Establishing less invasive, cheap, and widely available diagnostic markers for this underdiagnosed entity is essential, in particular for screening in high-risk groups. Nutrition-acquired osteomalacia is a bone mineralization disorder associated with dietary calcium and/or solar vitamin D deficiency, risk factors considered common in the Middle Eastern region. ![]()
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