Osteomalacia

Question 1

What is osteomalacia?

Answer 1

Softening of the bones secondary to low vitamin D levels

Question 2

What are the causes of osteomalacia?

Answer 2

Vitamin D deficiency
- Malabsorption
- Lack of sunlight
- Diet
CKD
Drug induced
Inherited - hypophosphataemic rickets
Liver disease
Coeliac disease

Question 3

What are the features of osteomalacia?

Answer 3

Bone pain
Bone/muscle tenderness
Fractures (especially femoral neck)
Proximal myopathy leading to waddling gait

Question 4

What investigations are carried out to diagnose osteomalacia?

Answer 4

Bloods
- Low vitamin D levels
- Low calcium and phosphate
- Raised ALP
XR
- Translucent bands

Question 5

What are the differentials of osteomalacia?

Answer 5

Primary hyperparathyroidism
Bone mets
Osteoporosis
Paget’s disease of the bone
Polymyalgia rheumatica
Rickets

Question 6

What bedside investigations are used in the diagnosis of osteomalacia?

Answer 6

Urinalysis - CKD
Urinary calcium - low
24 hour urinary phosphate

Question 7

What blood tests can be used in the diagnosis of osteomalacia?

Answer 7

Vitamin D
Calcium and phosphate
PTH
U&Es - CKD
LFTs - liver failure
FBC
Ferritin, B12 and folate - look for other deficiencies
Celiac serology

Question 8

What imaging may be used in the diagnosis of osteomalacia?

Answer 8

DEXA scan
Bone XR

Question 9

What is the management of osteomalacia?

Answer 9

Increase dietary intake of vitamin D
Advice about safe sun exposure

Loading dose of vitamin D - 300000 IU over 6 to 10 weeks
Maintenance dose of vitamin D - 800-2000 IU daily