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539

Osteomalacia: Melvin

L. Turner,1

Osteomalacia

and

and

of increasing to calcify

is made zones

result

from

K.

of bone

upon

or pseudofractures, various

etiobogic

three major groups 1 .-Deficiency ciency (lack phosphorus 2 .-Absorbtive testinal, and

disease,

tubular

acidosis

disease

can

that

cause

vitamin

exposure), (oxalate,

including disorders,

gastric, including tubular

congenital

renal

may

be divided

calcium phosphate).

or

pancreatic, postsurgical

in-

or

abnormalities.

tubular

into D defi-

defects

acidosis

of

tasia,

[4],

axial

osteomalacia

fibrogenesis

imperfecta

and gest

is occult

associated the correct

cases lying

of osteomalacia abnormality led

prognosis

Case

and

familiarity

diseases diagnosis.

form

the

with

the

basis

in the

for this

soft spine, a

has

Case

2

soft

(fig.

of

Pennsylvania,

a

on the dorsum

tissue

tumors

tissue

tumor.

anterior

ribs,

3 days

remained alkaline

1) revealed

of

below-knee

disappeared

and

between

of the vascular

and

rous,

University

discovered

of her

and

osteo-

the Bone pelvis,

and

revealed

amputation

was

after

surgery have

right

a

increased

knee.

a cavernous

hemanThe bone that time the

performed.

since

serum

returned

ischiopubic

demonstrated

revealed

and

The

phosphatase

foot

scan

lesion

asymptomatic.

bilateral

right

calcium,

phospho-

to a normal

level.

C. L. , a 77-year-old white man was evaluated for increasing bone and stiffness ofthe left hip. Radiography demonstrated bilateral (fig.

with

generalized

then

admitted

evaluation

cells.

and

left

femoral

coarsening to the

neck

of the

Hospital

bony

of the

pseudofractures trabecule.

University

(fig.

The

patient

2B) was

of Pennsylvania

for

of osteomalacia.

While unia,

2A)

in the hospital,

and

a bone

The

he was found

marrow

aspirate

osteomalacia

was

to have Bence revealed

thought

1 0%

Jones atypical

to be secondary

proteinplasma

to renal

os-

obvious when the underlying

various

etiologies

may enable the radiologist Our recent experience

in which the discovery to profound changes

association

the

was

Angiography

uptake

pain

of

mass

of the pelvis

vascular

gioma,

Hospital

tissue

suggested.

highly

scapular

osteomalacia include fibrous and osteopetrosis [4]; mediand phenolphthalein [5]; neomalignant, of either bone or soft causes, including hypophospha-

seum [5], and fluoride ingestion [4]. The cause of the osteomalacia is usually the radiographs are positive; occasionally, disorder

An was

Radiography

pain

osteodys-

the

pseudofractures.

renal

trophy.

Miscellaneous causes dysplasia, neurofibromatosis, cation including Dilantin plasms, both benign and tissues; and unclassified

foot.

malacia

patient

Acquired

or renal

at

soft

A biopsy primary

including

from

may

right

of

2]. Osteomalacia

,

Clinic

telangiectatic

seams

demonstration

Medical

[3]:

or ultraviolet and chelators

defects, hepatobiliary

defects. 3.-Renal

factors

by cartislowly.

osteoid

the

[1

as by Mankin states, including

of intake deficiency,

characterized

and epiphyseal so extremely

by widened

dependent

Causes

Dalinka1

matrix or does

histologically

is radiologically

looser

Murray

is an abnormality

an accumulation lage, which fails

Diagnosis

Uncommon

to sugwith two

of the underin therapy and

report.

Reports

Case H. H. , a 56-year-old black woman, had bone pain and fractures. She was followed for 8 years with a diagnosis onset hypophosphatemic osteomalacia (vitamin D resistant She was treated with calcium carbonate, phosphorous, doses of vitamin D with subjective benefit. As an outpatient

Received I

AJR

Department 133:539-540,

January

3, 1 979;

of Radiology,

September

accepted

Hospital

1979;

after

revision

of the University 0361

-803x/79/1

pseudoof adult rickets). and high in the

March 9, 1979. of Pennsylvania,

333-0539

3400

$00.00;

Fig. 1 -Case pelvic pseudofractures.

Spruce

© American

St.,

Philadelphia,

Roentgen

1 . Anteropostenior Contrast from

PA

1 91 04.

Ray Society

film of previous

Address

pelvis. Bilateral myelography

reprint

requests

symmetrical, is seen.

to M. K. Dalinka.

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540

CASE

Fig.

phosphate

leak

plasma

cell

due

2. A, Pseudofracture

to

light

dyscrasia.

phosphatunia, cemia.

2.-Case

chain

He

had

aminoacidunia,

The

treatment

patient

of myeboma,

placed

and

scapula.

Fanconi’s

without

prednisone

and

is currently

being

by the

syndrome

glycosunia

on

B, Coarse

all caused

proteinunia

classic

and

was

of right

with

hyperglyCytoxan

followed

as

for

1 , osteomalacia

and

This

removal

had

patient

this

years

cured

diagnosed

as

effect

relationship

therapy.

the relation since then

01. Most ofthe tumors tissue tumors, particularly

giopericytomas, tumor

[2],

have

also

but

osteomalacia substance second

admitted

the

hospital

by

light

the

(renal excretion

tissue

and

temia

[1 1 1 and with

erative

changes

pseudofracture

of left

osteomalacia. and in the

tubules

femoral

renal

tubules,

1979

neck.

Pathologically, osteomalacia

myeboma

convoluted

having

adult

have

by Mankin

neoplasms

onset

and

The

mechanism

2.

as

nonossifying

3.

the majority of exhibited degen-

especially

the proximal

[1 1].

P.

Arnstein

5.

giant

cell

fibroma

[2]

Med

B,

lacia

R,

8.

mildly of

secondary

deposition tubular

of phosphorous

caused acidosis

the renal

chains

proximal resulting

found

tubular in the

type

and

radiographic

he was to

of light

symptomatic

renal

renal 2)

with

was

Linovitz

9.

diagto have acidosis

1 0.

tubules.

tubular inappro-

in hypophospha-

.

and

2d

renal

osteodystrophy. 1974

HM:

Intern

Pak

J,

Recent

Med

progress

67

: 1 296-

HM, Reynolds

CYC,

osteo-

in

1 330,

1967

WA: Osteomalacia Arch

ingestion.

with

Reynolds

W,

a collagen

285:

Angan

defect

769-772,

Intern

RG:

non-endocrine

Fibno-

causing

osteo-

1 971

C: Hypophosphatemic

Arnaud

R,

Resnick JH,

D,

tumor.

Keissling

Deftos

J Bone

U:

Joint

Surg

S,

Nakamora

as

of

osteomalacia.

a cause

286,

1977

Renton

P,

Shaw

to vascular

osteoma-

N Eng!

J Med

238:

D: tumors

P,

Tumor [Am] T,

Kondon

58

Takaci

bone

soft

Nejdl

and

osteoblastoma

Surg

[BrJ

osteomalacia and

B,

1976

Benign

Joint

Hypophosphatemic

Sehler

osteomalacia

: 4 1 9-423, M:

J Bone

of

JJ,

induced

tissue.

59:279second-

Skeletal

Radiol

1976

Maldonaro Salassa 364,

Frost

ossium,

Jowsey

Rowe

1 :21-24, 1 1

HM,

Yoshikawa

ary

Bone,

1970

rickets.

only

the

1971

associated

RJ,

osteodystrophy. 1974

and

(phenolphthalein)

N Eng J Med

malacia. Salassa

28,

Metabolism

HL, Frost

imperfecta

65-70,

to be secondary to or other humeral

B, Ann

laxative

Frost

genesis 7.

Frame

128:794-796,

Frame

renal

Surg[Am156:352-386,

rickets.

by

and 1 01 -1

1968 osteomalacia

Joint

B, Guiang

induced

6.

Rickets,

AR,

Frame

Calcium

P: Davis,

and

56:

Surg(AmJ

Royer

II. J Bone

malacia

Prader

osteomalacia

Joint

HJ:

Part 4.

Rickets,

Philadelphia,

Mankin

of tumor-induced

but is thought D antagonist

HJ:

I. J Bone

Fourman

alleviated [3],

Mankin

Part

and rickets in been reported

such

[9],

.

ed.

described are benign, vascular hemangiomas and heman-

because

deposition

chain

dysfunction

a soft osteomalacia.

neoplasms cases have

On evaluation

syndrome

caused

priate

was

of osteomalacia.

Fanconi’s

The

patient

to

nosis

reported.

is unknown, of a vitamin by the tumor.

excretion

Our

bone

osteoblastoma

been

with the

would

As cited

between about 30

7-1

soft

associated

tumor

osteomalacia (e.g. , vitamin D resistant as such for about 8 years. An awareness

of needless

described 1 959, and

the

been

and

cause

was

of

hypophosphatemic rickets) and treated

the

trabeculae

patients

1

In case tumor,

,

osseous

September

REFERENCES

Discussion

[1

AJR:133,

an out-

patient.

of

REPORTS

JE, RM:

1975

Vebosa Fanconi

A,

Kyle

syndrome

RA,

Wagoner

in adults.

AD, Am

J Med

Holley

58:354-

KE,