MCQ – 72004

A 45 year old female presented with pain in the pelvic girdle.X ray shows the following features.What can be the most possible diagnosis?

A.	Osteogenesis Imperfecta
B.	Osteopetrosis
C.	Osteomalacia
D.	Hypoparathyroidism

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Correct Answer � C Explanation

Ans:C. Osteomalacia.

Image shows:Looser zones :Symmetric transverse lucent areas in the medial aspect of the femoral necks (arrows): a manifestation of osteomalacia. 

OSTEOMALACIA

• Vitamin D deficiency is the most common cause of osteomalacia
• Painful proximal muscle weakness (especially pelvic girdle); bone pain and tenderness.
• Decreased bone density from defective mineralization.
• Decrease in the rate of bone turnover and an increase in the amount of uncalcified osteoid.

Laboratory abnormalities

• Increased alkaline phosphatase
• Decreased 25-hydroxyvitamin D
• Hypocalcemia
• Hypocalciuria
• Hypophosphatemia
• Secondary hyperparathyroidism

Radiological features

• The classical feature: Pseudo fracture or Looser’s zone.
• Triradiate pelvis in females.
• Protrusion-acetabuli: acetabulum protruding into the pelvis.
• More commonly there is diffuse fading of skeleton leading to biconcave (cod fish) vertebra due to disc pressure and indentation of acetabulum producing trefoil or champagne glass pelvis.