Osteomalacia

Question 1

What is osteomalacia?

Answer 1

softening of the bones secondary to low vitamin D levels

Question 2

What is osteomalacia called when seen in children?

Answer 2

“rickets”

Question 3

Causes of osteomalacia

Answer 3

vitamin D deficiency (malabsorption/ lack of sun/ diet)
chronic kidney disease
drug induced e.g. anticonvulsants
inherited: hypophosphatemic rickets
liver disease: e.g. cirrhosis
coeliac disease

Question 4

Clinical features of osteomalacia

Answer 4

one pain
bone/muscle tenderness
fractures: especially femoral neck
proximal myopathy: may lead to a waddling gait

Question 5

Describe the pattern of calcium, phosphate, vitamin D and ALP levels in osteomalacia

Answer 5

low vitamin D
low calcium
low phosphate (in around 30%)
raised alkaline phosphatase (in 95-100% of patients)

Question 6

sign on XR

Answer 6

translucent bands (Looser’s zones or pseudofractures)

Question 7

Management of osteomalacia

Answer 7

vitamin D supplementation
calcium supplementation if dietary calcium is inadequate