Last revised by Ashesh Ishwarlal Ranchod on 14 Nov 2023

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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Cases and figures

  •  Case 1
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  • Case 2: triradiate pelvis
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  • Case 3: tumor-induced
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  • Case 4: Insufficiency fractures due to vitamin D deficiency
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  • Case 5: X-linked hypophosphatemia and looser zone
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