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A 46-year-old woman presents with a pain in the left leg that worsens on weight-bearing. An x-ray shows demineralization and a decalcified (EDTA-treated) biopsy shows reduction in bone quantity. The patient had undergone menopause at age 45 without estrogen replacement. She reports long-standing diarrhea. In addition, laboratory tests show low levels of 25- hydroxyvitamin D, calcium, and phosphorus and elevated alkaline phos- phatase. A second bone biopsy, which was not decalcified, shows uncalcified osteoid on all the bone surfaces. On the basis of these data, the most likely diagnosis would be

  1. Osteoporosis

  2. Osteomalacia

  3. Scurvy

  4. Paget’s disease

  5. Hypoparathyroidism


in Orthopedics by

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The answer is b.

The patient suffers from osteomalacia, a disease related to malnutrition, specifically vitamin D deficiency. On the basis of the first bone biopsy in which the tissue was decalcified, one could make a diagnosis of osteoporosis. The second, nonde- calcified bone biopsy indicates that osteoid is being formed but is not undergoing mineralization. This correlates with the low 25-hydroxyvitamin D levels. Vitamin D replacement and calcium supplementation would be prescribed for this patient.