Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • old age
  • vitamin D and calcium deficient diets
  • lack of sunlight exposure
  • FHx of osteomalacia
  • fractures
  • malabsorption syndromes
  • diffuse bone pain and tenderness
  • proximal muscle weakness
  • waddling gait

Other diagnostic factors

  • anticonvulsant therapy
  • steatorrhea

Risk factors

  • dietary calcium and vitamin D deficiency
  • limited sunlight exposure
  • chronic kidney disease
  • inherited disorders of vitamin D and bone metabolism
  • hypophosphatasia
  • mesenchymal tumors
  • Fanconi syndrome
  • anticonvulsant therapy

Diagnostic investigations

1st investigations to order

  • serum calcium level
  • serum 25-hydroxyvitamin D level
  • serum phosphate level
  • serum BUN and creatinine
  • intact PTH
  • serum alkaline phosphatase
  • 24-hour urinary calcium
Full details

Investigations to consider

  • bone x-rays
  • 24-hour urinary phosphate
  • DXA
  • iliac crest biopsy with double tetracycline labeling
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Bridget Sinnott

Associate Professor

Medical College Georgia

Augusta

GA

Disclosures

BS declares that she has no competing interests.

Dr Bridget Sinnott would like to gratefully acknowledge Dr Jelena Kravarusic, a previous contributor to this monograph. JK declares that she has no competing interests.

Peer reviewers VIEW ALL

Director

Endocrinology

Department of Internal Medicine

VA Medical Center

University of Iowa

Iowa City

IA

Disclosures

UK declares that he has no competing interests.

Department of Internal Medicine

Endocrinology & Diabetes

LMU University Munich

Munich

Germany

Disclosures

None declared.

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