Last reviewed: 5 Oct 2024
Last updated: 14 Jan 2021
Summary
Definition
History and exam
Key diagnostic factors
- old age
- vitamin D and calcium deficient diets
- lack of sunlight exposure
- fractures
- malabsorption syndromes
- diffuse bone pain and tenderness
- proximal muscle weakness
- family history of osteomalacia
- waddling gait
Full details
Other diagnostic factors
- anticonvulsant therapy
- steatorrhea
Full details
Risk factors
- dietary calcium and vitamin D deficiency
- limited sunlight exposure
- chronic kidney disease
- inherited disorders of vitamin D and bone metabolism
- hypophosphatasia
- anticonvulsant therapy
- mesenchymal tumors
- Fanconi syndrome
Full details
Diagnostic tests
1st tests 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
Tests to consider
- bone x-rays
- 24-hour urinary phosphate
- dual-energy x-ray absorptiometry
- iliac crest biopsy with double tetracycline labeling
Full details
Treatment algorithm
ONGOING
vitamin D deficient
inherited or acquired disorders of phosphate wasting, or oncogenic osteomalacia
Contributors
Authors
Bridget Sinnott, MD
Associate Professor
Medical College Georgia
Augusta
GA
Disclosures
BS declares that she has no competing interests.
Acknowledgements
Dr Bridget Sinnott would like to gratefully acknowledge Dr Jelena Kravarusic, a previous contributor to this topic. JK declares that she has no competing interests.
Peer reviewers
Udaya Kabadi, MD, FRCP(C), FACP, FACE
Director
Endocrinology
Department of Internal Medicine
VA Medical Center
University of Iowa
Iowa City
IA
Disclosures
UK declares that he has no competing interests.
Stephan Scharla, MD
Department of Internal Medicine
Endocrinology & Diabetes
LMU University Munich
Munich
Germany
Disclosures
None declared.
Differentials
- Osteoporosis
- Paget disease
More DifferentialsGuidelines
- Global consensus recommendations on prevention and management of nutritional rickets
- Dietary reference intakes for calcium and vitamin D
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