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Osteomalacia — SCE Rheumatology MCQ

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EasyMetabolic bone diseaseOsteomalaciaSCE Rheumatology

A 42-year-old woman has diffuse bone pain and proximal muscle weakness. Examination shows there is waddling gait and bony tenderness. Investigations show vitamin D is very low with raised alkaline phosphatase. The diagnosis is established and symptoms remain clinically important despite initial supportive measures. There is no contraindication to disease-modifying or anti-inflammatory escalation. What is the most appropriate management?

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Correct answer: D — Vitamin D replacement

Vitamin D replacement is the best answer because vitamin d replacement is the most appropriate next step for osteomalacia in this clinical setting. Specialist metabolic bone referral is a plausible distractor, but it does not account for the key discriminator in the stem. Calcium and vitamin D optimisation and Therapeutic exercise would be more appropriate in a different clinical pattern or at another point in the pathway, while Oral bisphosphonate therapy is suboptimal for this presentation. Clinical pearl: rheumatology management is generally treat-to-target, but infection risk, pregnancy plans and shared-care monitoring often determine the safest answer.

Reference: NICE CG146; NOGG guideline; BNF