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Osteomalacia Prevalence, Biochemical Profile, and Histology in Patients with Low-Energy Hip Fractures Over the Age of 45

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Abstract

Our objective was to determine the prevalence of osteomalacia in low-energy hip fracture patients over the age of 45, based on biochemical and histological measures. This cross-sectional study included 72 patients over 45 with low-energy mechanism hip fractures. Samples of fasting venous blood were taken for hemograms and serum biochemistry analyses. Bicortical biopsies of the iliac crest were obtained, processed, and evaluated by an expert pathologist for osteomalacia. Biochemical osteomalacia (b-OM) is defined according to a distinct criterion. A low level of serum calcium, phosphorus, albumin, and 25OHD was found in 43.1, 16.7, 73.6, and 59.7% of patients, respectively. 50.0% of patients had high serum alkaline phosphatase (ALP) levels. b-OM was found in 30 (41.7%), and no significant association was found with PTH, Cr, Alb, age, sex, fracture type, side of the trauma, and season were not associated with osteomalacia. Osteomalacia was diagnosed on histopathological analysis in 19/72 (26.7%), and 54/72 (75.0%) of all cases fulfilled b-OM criteria. In the histologic evaluation, osteoid seam width, osteoid surface, and osteoid volume were 28.5 µm, 25.6, and 12.1%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the biochemical test for detecting osteomalacia were 73.6, 64.2, 42.4, 87.2, and 66.7%, respectively. Up to 30% of elderly patients with low-energy hip fractures are affected by osteomalacia. A biochemical screening along with a bone biopsy and histopathologic evaluation may be logical in a high-risk population for osteomalacia diagnosis.

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Funding

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Authors and Affiliations

  1. Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Peyman Mirghaderi, Reza Mirghaderi & Alireza Moharrami

  2. Student Research Committee, Gonabad University of Medical Sciences, Gonabad, Iran

    Ali Mortezaei

  3. Department of Orthopaedic Surgery, Denver Health Medical Center, Denver, USA

    Joshua A. Parry & Maryam Salimi

  4. Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Peyman Mirghaderi, Ali Mortezaei, Reza Mirghaderi, Alireza Moharrami & S. M. Javad Mortazavi

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  1. Peyman Mirghaderi
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Contributions

PM: collected and analyzed data and edited the final manuscript. AM and RM: wrote the initial draft and edited the final manuscript. AM, MS, and JAP: contributed to the study concept and edited the final manuscript. SMJM: introduced the concept, supervised, and designed the study, and edited the final manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to S. M. Javad Mortazavi.

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Conflict of interest

Peyman Mirghaderi, Ali Mortezaei, Joshua A. Parry, Maryam Salimi, Reza Mirghaderi, Alireza Moharrami, and SM Javad Mortazavi (All authors) declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Mirghaderi, P., Mortezaei, A., Parry, J.A. et al. Osteomalacia Prevalence, Biochemical Profile, and Histology in Patients with Low-Energy Hip Fractures Over the Age of 45. Calcif Tissue Int 113, 257–265 (2023). https://doi.org/10.1007/s00223-023-01103-1

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