Osteomalacia

Last revised by Ashesh Ishwarlal Ranchod on 14 Nov 2023

Citation, DOI, disclosures and article data

Citation:

Niknejad M, Ranchod A, Silverstone L, et al. Osteomalacia. Reference article, Radiopaedia.org (Accessed on 03 Dec 2023) https://doi.org/10.53347/rID-21389

DOI:

https://doi.org/10.53347/rID-21389

Permalink:

https://radiopaedia.org/articles/21389

rID:

21389

Article created:

19 Jan 2013, Mohammad Taghi Niknejad ◉

Disclosures:

At the time the article was created Mohammad Taghi Niknejad had no recorded disclosures.

View Mohammad Taghi Niknejad's current disclosures

Last revised:

14 Nov 2023, Ashesh Ishwarlal Ranchod ◉

Disclosures:

At the time the article was last revised Ashesh Ishwarlal Ranchod had no financial relationships to ineligible companies to disclose.

View Ashesh Ishwarlal Ranchod's current disclosures

Revisions:

24 times, by 16 contributors - see full revision history and disclosures

Systems:

Musculoskeletal

Tags:

cases

Synonyms:

Osteomalacia: general
Osteomalacia (OM)

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

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)
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
decreased deposition of calcium in bone
- bisphosphonates (for the treatment of Paget disease)

Markers

25(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 cause⁵:

diffuse demineralization: osteoporotic-like pattern
- may show a characteristic smudgy "erased" or "fuzzy" type of demineralization ⁶
fuzzy/blurred appearance of the trabeculae ¹⁰
poor corticomedullary differentiation¹⁰
insufficiency fractures
- Looser zones
articular manifestations (uncommon)
- protrusio acetabuli
- rheumatoid arthritis-like changes
- osteogenic synovitis
- ankylosing spondylitis-like changes