Musculoskeletal ImagingOsteomalacia
a group of disorders resulting from inadequate or delayed mineralization of
osteoid in mature cortical and spongy bone, which in some ways is closely related to
rickets (an interruption in orderly development and mineralization of the growth plate). These two entities have similar gross
pathological, histological, and radiological findings. Among the causative factors of both disorders are abnormalities of vitamin D metabolism and syndromes resulting primarily from
renal tubular phosphate loss. Prior to closure of the growth plate, rickets and osteomalacia coexist.
Osteomalacia is characterized by abnormal quantities of osteoid coating the surfaces of trabeculae and lining the haversian canals in the cortex (osteoid seams). Loosers zones or Milkmans pseudofractures are strongly suggestive but not diagnostic of osteomalacia (Fig.1) (Fig.2). Frequently osteitis fibrosa cystica is superimposed on the lesions of osteomalacia.
Osteomalacia, Table 1. Some conditions associated with osteomalacia.
| Deficienty of vitamin D |
| Gastrointestinal malabsorption |
| Metabolic bone disease of premature infants |
| Liver disease (hepatic osteodystrophy (III:1) |
| Drug therapy (anticonvulsant agents) |
| Renal osteodystrophy (uraemic osteopathy) |
| Aluminium poisoning (dialysis osteomalacia) |
| Phosphate loss (X-linked hypophosphataemia |
| Tumour-associated osteomalacia |
| Atypical axial osteomalacia |
DR/RB
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AP radiograph of the shoulder demonstrates a Looser's zone in the lateral aspect of the scapula. This patient had osteomalacia owing to renal osteodystrophy.
(Courtesy of Thomas Broderick, MD, Orange, CA)
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Osteomalacia, Fig.1 | | Osteomalacia, Fig.2 | |