In the elderly, vitamin D deficiency is the most common cause and most likely due to inadequate dietary intake and in house-bound or institutionalised elderly patients with little or no exposure to sunlight. In the adults, the clinical significance of vitamin D deficiency may be subtle and overlooked and the patient being asymptomatic. X-rays show reduction in the skeletal density which is difficult to distinguish from osteoporosis. The changes in calcium, phosphate, ALP and 25(OH) D3 levels together with radiographic changes will help in making a diagnosis. There is general agreement that the vitamin 25 D level should be more than 50 nml/L, although some have suggested a threshold level of 60–70 nmol/L.
KeywordsOsteomalacia Vitamin D deficiency Exposure to sunlight Fractures
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