Personalized treatment pathways for adult osteomalacia

Osteomalacia, characterized by impaired mineralization of the bone matrix in adults, arises from various causes, with vitamin D deficiency being the most prevalent. Additional etiologies include genetic disorders of vitamin D metabolism and excessive renal phosphate wasting. If left untreated, osteomalacia can result in bone pain, hypocalcemia, fractures, and skeletal deformities. This review provides an overview of current therapeutic strategies for osteomalacia, encompassing both pharmacological and non-pharmacological treatments, as well as a step-by-step management algorithm. We conducted a narrative review, synthesizing data from recent studies on osteomalacia. Key interventions discussed include vitamin D supplementation, phosphate therapy, biologics, surgical correction, and percutaneous tumor ablation. The management of osteomalacia involves a multimodal approach, tailored to the underlying cause. Treatment options span pharmacological therapies (vitamin D, calcium, phosphate, and biologics) to surgical and minimally invasive procedures, ensuring comprehensive care for affected patients.