Osteomalacia — SCE Rheumatology MCQ

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EasyMetabolic Bone DiseaseOsteomalaciaSCE Rheumatology

A 38-year-old woman has diffuse bone pain, proximal muscle weakness and difficulty climbing stairs. She follows a strict vegan diet and rarely goes outdoors. Calcium is low-normal, phosphate is low, ALP is raised and 25-hydroxyvitamin D is severely low. What is the most likely diagnosis?

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Correct answer: B — Osteomalacia

Explanation lettering: D = shown as A · E = shown as B · B = shown as D · A = shown as E

Osteomalacia is best because bone pain, proximal myopathy, low phosphate, raised ALP and severe vitamin D deficiency indicate osteomalacia. A is less suitable because Paget disease causes focal high bone turnover rather than global vitamin D deficiency; B is less suitable because RA causes synovitis rather than metabolic bone pain; C is less suitable because PMR occurs in older adults with raised inflammatory markers; D is less suitable because fibromyalgia does not cause biochemical mineral abnormalities. Clinical pearl: osteomalacia causes weakness as well as bone pain because mineralisation is defective.

Reference: NICE CKS vitamin D deficiency; Oxford Textbook of Rheumatology