Osteomalacia

The finding of low bone mineral density with a T-score of -2.5 or below on dual energy x-ray absorptiometry is usually reported as indicating that the patient has "osteoporosis" according to the World Health Organization classification, and, in postmenopausal women, it is often assumed that this is due to estrogen deficiency. However, up to one third of postmenopausal women have a secondary cause of low density, including osteomalacia. Osteomalacia is defined as a mineralization defect caused by disorders that lead to decreased mineralization of bone. Clues from the history, physical examination, laboratory tests, and radiographs may indicate that the patient suffers from a form of osteomalacia rather than postmenopausal estrogen deficiency alone. Establishing a diagnosis of osteomalacia when present is critical to proper management of the patient.