Osteomalacia in Bedouin women of the Negev

In a retrospective survey of hospital admissions over the years 1980-89, primary nutritional osteomalacia was diagnosed in 20 patients, all of whom were Bedouin Arab women. Every patient suffered from bone pain and proximal muscle weakness, and fixed skeletal deformities were common. Mean serum alkaline phosphatase levels were mean ± SE 492 ± 72 (reference range 30-125 IU/ml). Mean 25-hydroxyvitamin D levels (in 12 cases) were 4.05 ± 0.66 ng/ml (Bedouin and Jewish female reference levels 15.1 ± 2.6 and 32.3 ± 3.3) respectively); in 9 of these 12 cases 24,25-dihyroxyvitamin D levels were 1.54 ± 0.51 ng/ml (Bedouin and Jewish reference levels 0.66 ± 0.1 and 2.44 ± 0.29 respectively); and 1,25-dihyroxyvitamin D levels were 49.3 ± 10.04 pg/ml (Bedouin and Jewish reference levels 83.6 ± 11.3 and 98.6 ± 12.3 respectively). This investigation shows that primary nutritional osteomalacia, a preventable disease, still occurs, causes severe morbidity and may be a manifestation of endemic subclinical vitamin D malnutrition in the Bedouin community in the Negev.