Osteomalacia

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Summary of Osteomalacia

Osteomalacia is the softening of the bones caused by defective bone mineralization secondary to inadequate levels of available phosphate and calcium, or because of overactive resorption of calcium from the bone which can be caused by hyperparathyroidism (which causes hypercalcemia). Osteomalacia in children is known as rickets, and because of this, use of the term "osteomalacia" is often restricted to the milder, adult form of the disease. Signs and symptoms can include diffuse body pains, muscle weakness, and fragility of the bones.

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Osteomalacia

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Osteomalacia

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A 40-year-old woman comes to the emergency department with severe right arm pain after a bad fall earlier in the day. Her temperature is 37.5°C (99.5°F), pulse is 70/min, respirations are 14/min, and blood pressure is 132/75 mmHg . Physical examination shows marked pain on palpation of the wrist and she does not want to move her hand because of significant pain. A radiograph of the right hand and arms shows a fracture of the scaphoid and radial head. A dual-energy x-ray absorptiometry (DEXA) scan shows a T-score of -1.0. Laboratory results show a parathyroid hormone level of 830 pg/mL, serum phosphate of 2.1 mg/dL, and a serum calcium of 6.5 mg/dL. Which of the following is the most likely cause of her fractures?

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