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Musculoskeletal manifestations of osteomalacia: report of 26 cases & literature review - fibromyalgia related research

  [ 41 votes ]   [ Discuss This Article ]
www.ProHealth.com • April 10, 1999


OBJECTIVE: This study was undertaken to describe the
musculoskeletal manifestations in a selected population of 26
patients with biopsy- proven osteomalacia (OM) and provide a
literature update.

METHODS: The 26 patients with biopsy-proven
OM were selected from a total number of 79 patients who
underwent anterior iliac crest biopsy. The diagnosis of OM was
confirmed by the presence of an osteoid volume greater than
10%, osteoid width greater than 15 microm, and delayed
mineralization assessed by double-tetracycline labeling.

RESULTS: OM was caused by intestinal malabsorption in 13
patients, whereas six other patients presented with
hypophosphatemia of different causes. Five elderly patients
presented with hypovitaminosis D, and in two patients the OM
was part of renal osteodystrophy. Twenty-three patients
presented with bone pain and diffuse demineralization, whereas
three other patients had normal or increased bone density.
Characteristic pseudofractures were seen in only seven
patients. Six of the 23 patients with diffuse demineralization
had an "osteoporotic-like pattern" without pseudofractures.
Prominent articular manifestations were seen in seven
patients, including a rheumatoid arthritis-like picture in
three, osteogenic synovitis in three, and ankylosing
spondylitis-like in one. Two other patients were referred to
us with the diagnosis of possible metastatic bone disease
attributable to polyostotic areas of increased radio nuclide
uptake caused by pseudofractures. Six patients also had
proximal myopathy, two elderly patients were diagnosed as
having polymalgia rheumatica, and two young patients were
diagnosed as having fibromyalgia. One of the patients who
presented with increased bone density was misdiagnosed as
possible fluorosis.

CONCLUSION: OM is usually neglected when
compared with other metabolic bone diseases and may present
with a variety of clinical and radiographic manifestations
mimicking other musculoskeletal disorders.

Reginato AJ, Falasca GF, Pappu R, McKnight B, Agha A




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