Preliminary Diagnosis: Osteomalacia

I. What imaging technique is first-line for this diagnosis?

  • Plain radiographs

II. Describe the advantages and disadvantages of this technique for diagnosis of Osteomalacia.

Advantages

  • Relatively quick imaging procedure that requires minimal patient cooperation

  • Inexpensive

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  • Readily available

  • Plain radiograph, despite often being a non-diagnostic exam, is useful when associated with clinical findings and serum biochemistry.

Disadvantages

  • Are nondiagnostic for osteomalacia

  • The demineralization can be identical to that seen in patients with osteoporosis

  • Exposure to ionizing radiation

III. What are the contraindications for the first-line imaging technique?

  • Pregnancy is a relative contraindication for plain radiographs. The small risk must be weighed against the benefit

IV. What alternative imaging techniques are available?

  • DEXA scan

  • Computed tomography (CT)

  • Magnetic resonance imaging (MRI)

  • Nuclear medicine (NM)

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of osteomalacia.

DEXA scan
Advantages

  • In the elderly, associated osteoporosis can also be seen with reduction of bone density by DEXA scan

  • Most accurate and valuable method for evaluation of bone density, and one of the best methods to estimate the risk of fractures

  • Noninvasive, quick and simple method

  • The amount of radiation used is small

  • Widely available bone densitometry test available for the diagnosis of bone density abnormalities

Disadvantages

  • Nondiagnostic for osteomalacia

Computed Tomography
Advantages

  • Helps to evaluate associated pathologic fracture

Disadvantages

  • Nondiagnostic for osteomalacia

  • Exposure to ionizing radiation

Magnetic Resonance Imaging
Advantages

  • Helps evaluate soft tissues for ligament rupture and can evaluate pathologic fracture

  • Does not make use of ionizing radiation and may be performed in pregnant patients

Disadvantages

  • Nondiagnostic for osteomalacia

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize artifact

Nuclear Medicine
Advantages

  • NM can reveal pseudofractures and extraskeletal ossification

Disadvantages

  • Nondiagnostic for osteomalacia

  • Weak anatomical analysis

  • Relatively expensive

  • Radiation risks due to administered radionuclide

VI. What are the contraindications for the alternative imaging techniques?

DEXA scan

  • Pregnancy, although radiation exposure with central DEXA assessments is minimal

  • Individuals who have recently had gastrointestinal contrast or a nuclear medicine test should wait at least 72 hours to perform a DEXA scan, as these tests can affect the results of the scan.

Computed tomography

  • Contraindicated in pregnant women, especially within the first two trimesters

Magnetic resonance

  • Contraindicated in patients with non–MR-compatible metallic hardware or foreign bodies

Nuclear Medicine

  • Contraindicated in pregnant women and those who are breastfeeding

  • May not be suitable for pregnant women. The risk versus benefit should be discussed with the nuclear medicine specialist.

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