Low Prevalence of Exploratory Biochemical Patterns Compatible with Osteomalacia in a Large Cohort of Participants with Low Serum 25-Hydroxyvitamin D Levels
In brief
Only 8.3% with low vitamin D met the broadest exploratory pattern
Among 423 participants with a mean vitamin D level of 34 nmol/L, none had the combination of high parathyroid hormone, high alkaline phosphatase and low calcium; 8.3% met the most permissive exploratory pattern. Supplementation shifted these blood markers, but without bone biopsy validation, the patterns cannot establish osteomalacia prevalence or a vitamin D deficiency threshold.
- Journal
- Calcified tissue international (Q1)
- Published
- 23 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Rolf Jorde, Per Medbøe Thorsby, Guri Grimnes
- PMID
- 42776204
- DOI
- 10.1007/s00223-026-01612-9
Why clinicians should know about it
- Picked for Pathology and Forensic Medicine (top studies of the week, 27 September 2026): Low prevalence of biochemical osteomalacia patterns
Abstract
The threshold for vitamin D deficiency is mainly based on osteomalacia prevention. Osteomalacia is diagnosed by bone biopsy, but may potentially also be identified biochemically. Our objective was to examine the prevalence of exploratory biochemical patterns compatible with osteomalacia in a population with low vitamin D status, as well as the effect of vitamin D supplementation on the biochemical parameters. The study was cross-sectional followed by a randomized controlled trial (trial registration number: NCT02750293). The participants were recruited from the population-based Tromsø study. Plasma parathyroid hormone, serum calcium, alkaline phosphatase and bone-specific alkaline phosphatase were measured. 423 participants were included in the cross-sectional part and 382 completed the randomized controlled trial (194 given vitamin D (100,000 IU as a loading dose followed by 20,000 IU per week for four months) and 188 given placebo). The mean serum 25-hydroxyvitamin D level in the cohort was 34 nmol/L. None of the participants had a combination of high (above reference range) serum parathyroid hormone, high alkaline phosphatase, and low (below reference range) serum calcium. With the most permissive exploratory biochemical pattern the prevalence was 8.3%. In the intervention study vitamin D significantly reduced plasma parathyroid hormone and alkaline phosphatase and increased serum calcium as compared to placebo. In conclusion, the prevalence of the explored biochemical patterns compatible with ostemalacia was low and strongly dependent on the analytical thresholds applied. In the absence of validation against bone histomorphometry, these findings cannot determine the prevalence of osteomalacia or establish an appropriate serum 25OHD threshold.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.