Osteomalacia
Updates to Article Attributes
Body
was changed:
Osteomalacia is bone softening due to insufficient mineralisation of the osteoid secondary to any process that results in vitamin D deficiency or defects in phosphate metabolism:
- high remodelling rate: excessive osteoid formation with normal/little mineralisation
- low remodelling rate: normal osteoid production with diminished mineralisation
Epidemiology
Because of the many causes of osteomalacia worldwide, the epidemiology is highly variable 9.
Clinical presentation
Patients with osteomalacia may be asymptomatic or present with bone pain/tenderness and/or muscular weakness.
Pathology
Aetiology
- vitamin D deficiency (most common)
- inadequate intake or absorption
- dietary deficiency of vitamin D
- lack of sunlight exposure
- gastric surgery (e.g., gastrectomy or gastric bypass)
- small bowel disease (e.g., Crohn disease, celiac disease)
- pancreatic insufficiency (e.g. cystic fibrosis)
- deficiency of vitamin D metabolism
- cirrhosis (25-hydroxylation of vitamin D)
- chronic kidney disease (1-hydroxylation of 25-vitamin D)
- cytochrome P450 inducers (e.g. phenobarbital, antiepileptic drugs)
- inadequate intake or absorption
- phosphate deficiency
- inadequate intake or absorption
- antacids
- renal phosphate wasting
- hereditary hypophosphatemic rickets
- Fanconi syndrome
- tumor-induced (oncogenic) osteomalacia, most commonly due to phosphaturic mesenchymal tumor
- inadequate intake or absorption
- decreased deposition of calcium in bone
- bisphosphonates (for the treatment of Paget disease)
Markers
- 25
OH-vitamin D(OH)D: decreased - serum calcium: slightly decreased / normal
- urinary calcium: decreased
- serum phosphorus: decreased
- serum alkaline phosphatase: elevated
- serum parathyroid hormone: elevated
Radiographic features
Musculoskeletal
There can be variable appearances dependent on the cause 5:
- diffuse demineralisation: osteoporotic-like pattern
- may show a characteristic smudgy "erased" or "fuzzy" type of demineralisation 6
- coarsened trabeculae
- insufficiency fractures
- articular manifestations (uncommon)
- protrusio acetabuli
- rheumatoid arthritis-like changes
- osteogenic synovitis
- ankylosing spondylitis-like changes
-<li>25 OH-vitamin D: decreased</li>- +<li>25(OH)D: decreased</li>
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