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Osteomalacia CKD — ESENeph MCQ

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ModerateChronic Kidney DiseaseOsteomalacia CKDESENeph

A 55-year-old man with CKD G5D on haemodialysis presents with bone pain in his ribs and pelvis. X-rays show Looser zones (pseudofractures). His calcium is 1.9 mmol/L, phosphate 1.2 mmol/L, PTH 12 pmol/L, ALP is markedly elevated, and 25-OH vitamin D is 12 nmol/L. What type of renal osteodystrophy is most likely?

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Correct answer: B — Osteomalacia

Looser zones (pseudofractures) are pathognomonic for osteomalacia. The combination of low calcium, low-normal phosphate, low vitamin D, low-normal PTH (relative to CKD stage), and markedly elevated ALP (indicating attempted but unsuccessful mineralisation) is characteristic of vitamin D deficiency-related osteomalacia in CKD. In CKD, the inability to hydroxylate 25-OH vitamin D to 1,25-dihydroxyvitamin D compounds the deficiency. Treatment requires both native vitamin D repletion and active vitamin D (Alfacalcidol/Calcitriol).

Reference: KDIGO 2017 – CKD-MBD Guideline