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osteomalacia

Etiology: - vitamin D deficiency (see vitamin D deficiency) - celiac disease - chronic renal failure - liver disease - anticonvulsant therapy Epidemiology: - rickets is osteomalacia in children Pathology: - lack of available calcium or phosphorus - bone matrix is normal, but undermineralized Clinical manifestations: 1) non-specific bone pain is common - aching pain with weight-bearing (osteomalacia) - no simple relationship between pain & vit D status - palpation of arms & legs may reproduce pain 2) proximal muscle weakness 3) difficulty walking (limited distance), waddling gait, no ataxia 4) fatigue, malaise, weight loss Laboratory: - 25-OH vitamin D in serum is very low - serum calcium & serum phosphate are low - serum PTH is high - serum alkaline phosphatase is high - see vitamin D deficiency Special laboratory: - bone biopsy as indicated Radiology: - bone scan - generalized uptake of technetium throughout skeleton with foci of intense uptake - X-ray as indicated - bands perpendicular to surface of bone (looser zones) Complications: - bone fracture, especially in nursing home residents Differential diagnosis: - osteitis fibrosa cystica - Paget's disease of bone - generally asymptomatic, serum calcium, serum phosphorus generally normal - osteoporosis (no pain unless fracture) Management: - calcium & vitamin D (high dose) generally rapid corrects deficiency & heals bone [1] - ergocalciferol 1000-2000 PO IU QD - calcium supplement 1000 mg PO QD

Related

vitamin D deficiency

Specific

rickets; juvenile osteomalacia; infantile osteomalacia tumor-induced osteomalacia (oncogenic osteomalacia)

General

bone disease; osteopathia metabolic disease

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 16, 18. American College of Physicians, Philadelphia 2012, 2018 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  2. Uday S, Hogler W. Nutritional Rickets and Osteomalacia in the Twenty-first Century: Revised Concepts, Public Health, and Prevention Strategies. Curr Osteoporos Rep. 2017 Aug;15(4):293-302. Review. PMID: 28612338 Free PMC Article
  3. Kim SW. Hong N, Rhee Y et al Clinical and laboratory features of patients with osteomalacia initially presenting with neurological manifestations. Osteoporos Int. 2018 Jul;29(7):1617-1626 PMID: 29623355 https://link.springer.com/article/10.1007/s00198-018-4501-1
  4. Russell LA Osteoporosis and osteomalacia. Rheum Dis Clin North Am. 2010 Nov;36(4):665-80 PMID: 21092845 Review.