Osteomalacia

Basics

• normal bony tissue but decreased mineral content
• rickets if when growing
• osteomalacia if after epiphysis fusion

Types

• vitamin D deficiency e.g. malabsorption, lack of sunlight, diet
• renal failure
• drug induced e.g. anticonvulsants
• vitamin D resistant; inherited
• liver disease, e.g. cirrhosis

Features

• rickets: knock-knee, bow leg, features of hypocalcaemia
• osteomalacia: bone pain, fractures, muscle tenderness, proximal myopathy

Investigation

• low calcium, phosphate, 25(OH) vitamin D
• raised alkaline phosphatase
• x-ray: children - cupped, ragged metaphyseal surfaces; adults - translucent bands (Looser's zones or pseudofractures)

Treatment

• calcium with vitamin D tablets