Last revised by Rohit Sharma on 21 Feb 2024

Osteomalacia is bone softening due to insufficient mineralization of the osteoid secondary to any process that results in vitamin D deficiency or defects in phosphate metabolism:

  • high remodeling rate: excessive osteoid formation with normal/little mineralization

  • low remodeling rate: normal osteoid production with diminished mineralization

Because of the many causes of osteomalacia worldwide, the epidemiology is highly variable 9

Patients with osteomalacia may be asymptomatic or present with bone pain/tenderness and/or muscular weakness. 

  • 25(OH)D: decreased

  • serum calcium: slightly decreased / normal

  • urinary calcium: decreased

  • serum phosphorus: decreased

  • serum alkaline phosphatase: elevated

  • serum parathyroid hormone: elevated

There can be variable appearances dependent on the cause 5:

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