Osteomalacia(骨軟化症）

基本的に専門医試験対策のために書いているので患者様の治療情報提供でないことを再度確認しておきたい。

radiopediaに骨シンチあると嬉しいですよね。

Osteomalacia | Radiology Reference Article | Radiopaedia.org

画像診断的には

insufficiency fractures

• Looser zones

• articular manifestations (uncommon)

  • protrusio acetabuli

  • rheumatoid arthritis-like changes

  • osteogenic synovitis

  • ankylosing spondylitis-like changes

多分これを覚えればよさそう。

臨床的にはというか国試的には病因が重要そう。そういうところがなんか違うんですよね。

vitamin D deficiency (most common)

• inadequate intake or absorption

  • dietary deficiency of vitamin D

  • lack of sunlight exposure

  • gastric surgery (e.g., gastrectomy or gastric bypass)

  • small bowel disease (e.g., Crohn disease, coeliac disease)

  • pancreatic insufficiency (e.g. cystic fibrosis)

• deficiency of vitamin D metabolism

  • cirrhosis (25-hydroxylation of vitamin D)

  • chronic kidney disease (1-hydroxylation of 25-vitamin D)

  • cytochrome P450 inducers (e.g. phenobarbital, antiepileptic drugs)

• phosphate deficiency

  • inadequate intake or absorption

    • antacids

  • renal phosphate wasting

    • hereditary hypophosphataemic rickets

    • Fanconi syndrome

    • tumour-induced (oncogenic) osteomalacia, most commonly due to phosphaturic mesenchymal tumour

• decreased deposition of calcium in bone

  • bisphosphonates (for the treatment of Paget disease)

病因です。