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Re: A possible re-emergence of osteomalacia in women and severe hypovitaminosis D in new-born in France

Dear Editor,

We found the article of S H Dijkstra et al (1) very interesting. We recently conducted a study in 93 non-pregnant women, aged 20 to 50 years, to determine the prevalence of vitamin D deficiency in women at risk of vitamin D deficiency because of their wearing of concealing clothes (such as a veil). This prospective study was performed between December 2004 and January 2005 in general practitioner setting in Lyon France. We found that almost 99% of these young women had a mild D deficiency (25-hydroxyvitamin D< 53 nmol/l), 83% had a severe deficiency (25-hydroxyvitamin D< 30 nmol/l) and 14% had no vitamin D at all. These results can be compared with those of a national survey, SUVIMAX, of 1500 healthy volunteers aged 35-65 years. This survey showed the overall prevalence of vitamin D deficiency in France was 14% (vitamin D <30 nmol/l) and 9% in the Lyon region (2). Other European studies have shown a long delay between first symptoms and appropriate diagnosis (2 to 2.5 years in average), and that women often end up with a diagnosis of depression or “psychological disorder” but no appropriate treatment (3). In our sample, 73% of the women suffered chronic pain and fatigue that had lasted for more than 6 months at the time of the study. None of them had been diagnosed nor treated appropriately and 35% had had at least one hospitalisation during the preceding 6 months.

In France, there are increasing numbers of women wearing concealing clothes especially in urban regions such as the area of Lyon. This phenomenon is quite recent, thus general practitioners are not aware that these women represent a group at high risk of severe vitamin D deficiency. Furthermore, the question of vitamin D deficiency does not appear to be well recognised in our country where most food products are not supplemented with vitamin D. We haven’t been successful so far in our efforts to set up a program of prevention and implementation of guidelines following our descriptive study. It seems that the medical community apparently do not believe this is an important public health problem. If we don’t succeed in increasing the awareness of this problem in the health community we may well see a re-emergence of osteomalacia in adults and probably deleterious consequences in children as Dijkstra et al demonstrated in their study.

1-Dijkstra S H, van Beek A, Janssen J W, de Vleeschouwer L H M, Huysman W A, van den Akker E L T. High prevalence of vitamin D deficiency in newborn infants of high-risk mothers. Arch. Dis. Child. 2007;92:750- 753.

2-Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, Meunier PJ. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int. 1997;7(5):439-443.