01-03-2009, 08:13 PM
Correct Answer = B)
* Osteomalacia is a metabolic bone disease with failure of the organic matrix (osteoid) of bone to mineralize normally in adults.
* Looser's zones or Milkmans' fractures (pseudofractures) on radiography are pathognomonic of osteomalacia.
Osteomalacia is a type of metabolic bone disease with failure of the organic matrix (osteoid) of bone to mineralize normally. The essential problem is a lack of available calcium or phosphorus (or both) for mineralization of newly formed osteoid. Many cases of osteomalacia are related to abnormalities in vitamin D. In this patient with pancreatic insufficiency, vitamin D deficiency is the likely cause of osteomalacia. Patients generally complain of easy fatigability, malaise, and bone pain. The pain is diffuse and poorly localized and is accompanied by a generalized tenderness of bones. Fracture in an elderly patient that is thought to be the result of osteoporosis may be the first sign of osteomalacia. Proximal muscle weakness is often seen in severe cases and the patient may have waddling gait.
Looser's zones or Milkmans' fractures (pseudofractures) are pathognomonic on radiography. They are radiolucent bands, due to defects in bone that are perpendicular to the bone surface. They are usually symmetric and bilateral. Characteristic locations include the inner aspects of the femur, the pubic rami, and the outer edges of the scapula. Pseudofractures occur where major arteries cross bones. Hypocalcemia and hypophosphatemia (which can be quite profound) are seen, except in renal osteodystrophy where the phosphorus level is invariably high and the calcium level low. The alkaline phosphatase level is usually elevated in all forms of osteomalacia (except hypophosphatasia).
Paget's disease of bone does not present clinically in this manner. Additionally, in the face of a normal PSA and normal digital rectal examination the diagnosis of prostate cancer is highly doubtful. Similarly, in the absence of cancer the diagnosis of a paraneoplastic syndrome is implausible.
Bibliography
* Osteomalacia is a metabolic bone disease with failure of the organic matrix (osteoid) of bone to mineralize normally in adults.
* Looser's zones or Milkmans' fractures (pseudofractures) on radiography are pathognomonic of osteomalacia.
Osteomalacia is a type of metabolic bone disease with failure of the organic matrix (osteoid) of bone to mineralize normally. The essential problem is a lack of available calcium or phosphorus (or both) for mineralization of newly formed osteoid. Many cases of osteomalacia are related to abnormalities in vitamin D. In this patient with pancreatic insufficiency, vitamin D deficiency is the likely cause of osteomalacia. Patients generally complain of easy fatigability, malaise, and bone pain. The pain is diffuse and poorly localized and is accompanied by a generalized tenderness of bones. Fracture in an elderly patient that is thought to be the result of osteoporosis may be the first sign of osteomalacia. Proximal muscle weakness is often seen in severe cases and the patient may have waddling gait.
Looser's zones or Milkmans' fractures (pseudofractures) are pathognomonic on radiography. They are radiolucent bands, due to defects in bone that are perpendicular to the bone surface. They are usually symmetric and bilateral. Characteristic locations include the inner aspects of the femur, the pubic rami, and the outer edges of the scapula. Pseudofractures occur where major arteries cross bones. Hypocalcemia and hypophosphatemia (which can be quite profound) are seen, except in renal osteodystrophy where the phosphorus level is invariably high and the calcium level low. The alkaline phosphatase level is usually elevated in all forms of osteomalacia (except hypophosphatasia).
Paget's disease of bone does not present clinically in this manner. Additionally, in the face of a normal PSA and normal digital rectal examination the diagnosis of prostate cancer is highly doubtful. Similarly, in the absence of cancer the diagnosis of a paraneoplastic syndrome is implausible.
Bibliography