Osteomalacia

Last reviewed: 4 Sep 2022
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
More key diagnostic factors

Other diagnostic factors

  • anticonvulsant therapy
  • steatorrhea
Other diagnostic factors

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
More risk factors

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
More 1st investigations to order

Investigations to consider

  • bone x-rays
  • 24-hour urinary phosphate
  • dual-energy x-ray absorptiometry
  • iliac crest biopsy with double tetracycline labeling
More investigations to consider

Treatment algorithm

ONGOING

vitamin D deficient

inherited or acquired disorders of phosphate wasting, or oncogenic osteomalacia

Contributors

Authors

Bridget Sinnott, MD
Bridget Sinnott

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.

  • Osteomalacia images
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  • Guidelines

    • Global consensus recommendations on prevention and management of nutritional rickets
    • Dietary reference intakes for calcium and vitamin D
    More Guidelines
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