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Osteomalacia — SCE Rheumatology MCQ

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ModerateMetabolic bone diseaseOsteomalaciaSCE Rheumatology

A 69-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 consultant wants the next test most likely to confirm the suspected process or guide treatment. The result will change diagnosis, staging or immediate treatment. What is the most appropriate investigation?

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Correct answer: C — Bone profile and vitamin D

Bone profile and vitamin D is the best answer because bone profile and vitamin d is the investigation most likely to resolve the immediate diagnostic or monitoring question in osteomalacia. Alkaline phosphatase isoenzymes is a plausible distractor, but it does not account for the key discriminator in the stem. MRI scan and PTH level would be more appropriate in a different clinical pattern or at another point in the pathway, while Urinalysis is suboptimal for this presentation. Clinical pearl: autoantibodies are supportive tests and should be interpreted alongside phenotype, inflammatory markers, urinalysis and imaging.

Reference: NICE CG146; NOGG guideline; BNF