ORTHO BULLETS SEARCH Melanio Acosta IV

Updated: 3/30/2020
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Basic Science
Osteomalacia
MSK SCIENCE Colin Woon

BONE BASIC SCIENCE TOPIC

Review Topic
BONE FORMATION &
HEALING

BIOLOGIC TISSUES

MOLECULAR BIOLOGY

MATERIAL SCIENCE

SYSTEMIC DISEASE

METABOLIC BONE Introduction

DISEASE

Osteopenia & Osteoporosis A metabolic bone disease where defective mineralization results in a large amount or unmineralized osteoid
qualitative defect as opposed to a quanitative defect like osteoporosis
Renal Osteodystrophy
rickets and osteomalacia are manifestations of the same pathologic process
Rickets Epidemiology
Osteomalacia incidence
rare in the US (approximately 1 in 1000)
Oncogenic Osteomalacia
much less common than osteoporosis
SYSTEMIC because of adequate exposure to sunlight and dairy products fortified with vitamin D
ARTHROPATHIES demographics
rickets is found in children (open physis)
THROMBOEMBOLISM
osteomalacia is found in adults (closed physis)
HEMATOLOGIC DISEASE risk factors
the following conditions predispose a patient to osteomalacia
NEUROLOGIC vitamin-D deficient diets
DISEASES malabsorption e.g. celiac disease
renal osteodystrophy
SYSTEMIC DISEASES
hypophosphatemia
METABOLIC DISEASE chronic alcoholism
tumors (tumor-induced osteomalacia)
MEDICATIONS & TOXICITY drugs
drugs associated with vitamin D deficiency
MEDICATIONS phenytoin
phenobarbital
TOXICOLOGY
rifampin
CLINICAL SCIENCE cholestyramine
cadmium
CLINICAL STUDIES glucocorticoids
drugs affecting phosphate homeostasis
HEALTHCARE aluminium-containing phosphate-binding antacid
WORPLACE
ifosfamide
PRACTICE drugs affecting bone mineralization
MANAGEMENT aluminium
etidronate
fluoride

Presentation

Symptoms
generalized bone and muscle pain
fractures of long bones, ribs and vertebrae
proximal muscle weakness weakness
fatigue
Physical exam
inspection
waddling gait
from hip pain and thigh weakness
difficulty rising from chair and climbing stairs

Imaging

Radiographs
findings
Looser's zones (insufficiency fractures)
medial femoral cortex
pubic ramus
scapula
fractures (especially in the proximal femur/femoral neck)
biconcave vertebral bodies
trefoil pelvis
protrusio acetabuli
Bone scan
findings
increased activity

Studies

Labs

Serum Ca Serum P Alk phos PTH 25-(OH)vit D 1,25-(OH)vit D Urinary Ca

Osteomalacia low low high high low low low
Osteoporosis normal normal variable normal normal normal normal
Tumor induced
low very low low low low low low
osteomalacia
Osteopetrosis normal normal high normal normal normal normal

Histology
requires transiliac biopsy for definitive diagnosis

Histology

Characteristic histology includes

technique
requires transiliac biopsy for definitive diagnosis
findings
widely separated osteoid seams
greater amounts of unmineralized osteoid than normal

Treatment

Nonoperative
large doses of oral vitamin D (1000IU/day), treat underlying cause
indications
most patients
technique
specific subgroups of patients
on long-term anticonvulsant therapy
supplement with 400-800IU/day of vitamin D
with hepatobiliary disease
supplement with 25(OH)-vit D
with renal disease
supplement with 1,25(OH)2 vit D

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RECENT COMMENT

Ryan Berger 7:51AM on 03/30/20

Dr. Rady, in younger patients the same principles for treating femoral neck fractures should apply. For a non-
displaced fracture, perc pinning is the way to go. Here is a case study I found of a 37-year-old male with
atraumatic bilateral femoral neck fxs found to have osteomalacia. The fractures were non-displaced, he was
treated with bilateral perc pinning, his underlying vitamin D deficiency was corrected, and he was doing great at
6-month follow-up. I think the key here is treating the fracture as one normally would and making sure to detect
and address the underlying metabolic issue. Best, Ryan

Yoon BH, Kwon MS. Atraumatic Bilateral Fracture of the Femoral Neck in Young Male Patient with Suspected
Osteomalacia. J Bone Metab. 2017;24(3):197–200. doi:10.11005/jbm.2017.24.3.197

Comments (17)

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Topics Techniques QBank Evidence Cases Videos Podcasts Groups Products Help
Basic Science

MSK SCIENCE

BONE BASIC SCIENCE

BONE FORMATION &

HEALING

BIOLOGIC TISSUES

MOLECULAR BIOLOGY

MATERIAL SCIENCE

SYSTEMIC DISEASE

METABOLIC BONE
DISEASE

Osteopenia & Osteoporosis

Renal Osteodystrophy

Rickets

Osteomalacia

Oncogenic Osteomalacia

SYSTEMIC
ARTHROPATHIES

THROMBOEMBOLISM

HEMATOLOGIC DISEASE

NEUROLOGIC
DISEASES

SYSTEMIC DISEASES

METABOLIC DISEASE

MEDICATIONS & TOXICITY

MEDICATIONS

TOXICOLOGY

CLINICAL SCIENCE

CLINICAL STUDIES

HEALTHCARE
WORPLACE

PRACTICE
MANAGEMENT