Osteomalacia — SCE Rheumatology MCQ

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EasyMetabolic bone diseaseOsteomalaciaSCE Rheumatology

A 24-year-old man 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 admitting team asks which diagnosis best explains the whole presentation. What is the most likely diagnosis?

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Correct answer: B — Osteomalacia

Osteomalacia is the best answer because the pattern described is most consistent with Osteomalacia, including the distribution of symptoms and the targeted investigation results. SLE is a plausible distractor, but it does not account for the key discriminator in the stem. Acute CPP crystal arthritis and Septic arthritis would be more appropriate in a different clinical pattern or at another point in the pathway, while Rotator cuff tendinopathy is suboptimal for this presentation. Clinical pearl: in SCE-style questions, the decisive clue is usually the pattern across joints, extra-articular features and targeted immunology rather than a single antibody result.

Reference: NICE CG146; NOGG guideline; BNF