Osteomalacia

Case contributed by Dr Dalia Ibrahim

Presentation

Pelvic pain.

Patient Data

Age: 24-year-old
Gender: Female
X-ray
  • Triradiate appearance of the pelvis with bilateral acetabula protrusio.
  • Osteopenic texture of the examined bones with coarse trabeculae.
  • Right superior and inferior pubic rami Looser's zones.
  • Subchondral bone absorption of acroiliac joints (more on the right).
MRI

MRI exam of the pelvis showed:

  • Triradiate appearance of the pelvis with bilateral acetabula protrusio.
  • Right superior and inferior pubic rami looser's zones. Also note the marrow edema of the left femoral neck, likely stress fracture.
  • Subchondral bone absorption of acroiliac joints (more on the right).
Annotated image

Red arrows: represent stress fractures (looser's zones)

Yellow arrows: represent subchondral bony resorption at the sacroiliac joint.

Case Discussion

The patient had a history of chronic renal disease.

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.

Radiographic features

Musculoskeletal

There can be variable appearances dependent on the cause :

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