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

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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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