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Osteomalacia — SCE Rheumatology MCQ

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ModerateMetabolic bone diseaseOsteomalaciaSCE Rheumatology

A 43-year-old woman with coeliac disease has diffuse bone pain and proximal muscle weakness. Calcium is 1.98 mmol/L, phosphate is low, ALP is high and 25-hydroxyvitamin D is 14 nmol/L. X-ray shows Looser zones. What is the most likely diagnosis?

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Correct answer: E — Osteomalacia

Vitamin D deficiency with hypocalcaemia, hypophosphataemia, raised ALP and Looser zones indicates osteomalacia. Osteoporosis causes fragility fractures with normal mineralisation and does not cause Looser zones. Treating malabsorption and replacing vitamin D and calcium are central.

Reference: NICE CKS Vitamin D deficiency; BSR rheumatology curriculum