Here is a table listing laboratory tests seen in osteomalacia
Here is an xray showing a pseudofracture (red arrow) from an adult who has x-linked hypophosphatemic rickets. This sign is seen only in osteomalacia, but not in many of the cases.
This knee shows thick growth plates that appear fuzzy. The bone near the joint is too wide.
Bone biopsies are the most definite way to diagnose osteomalacia. Many times the diagnosis can be made without a biopsy, but in confusing cases it is important. The bone biopsy must be processed so we can see the difference between osteoid and mineralized bone. The usual way to look at a bone biopsy for cancer is to dissolve all the mineral out of the specimen. But then you can't tell if there is a problem with osteomalacia!
One important cause of osteomalacia is low blood phosphate. The urine phosphate is controlled by several hormones, which have recently been defined. This helps us understand why some people with rare tumors that secrete certain hormones can have bone disease that is similar to an inherited kind of rickets.
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