Division of Endocrinology, Diabetes and Bone & Mineral Disorders, Henry Ford Hospital, Detroit, MI 48202, USA.
Rheum Dis Clin North Am. 2012 Feb;38(1):81-91, viii-ix. doi: 10.1016/j.rdc.2012.03.008. Epub 2012 Apr 12.
Osteomalacia is an end-stage bone disease of chronic and severe vitamin D or phosphate depletion of any cause. Its importance has increased because of the rising incidence of vitamin D deficiency. Yet, not all cases of osteomalacia are cured by vitamin D replacement, and furthermore, not all individuals with vitamin D deficiency develop osteomalacia. Although in the past osteomalacia was commonly caused by malabsorption, nutritional deficiency now is more common. In addition, recent literature suggests that nutritional vitamin D deficiency osteomalacia follows various bariatric surgeries for morbid obesity. Bone pain, tenderness, muscle weakness, and difficulty walking are all common clinical manifestations of osteomalacia. Diagnostic work-up involves biochemical assessment of vitamin D status and may also include a transiliac bone biopsy. Treatment is based on aggressive vitamin D repletion in most cases with follow-up biopsies if patients are started on antiresorptive or anabolic agents.
骨质软化症是一种由任何原因引起的慢性、严重的维生素 D 或磷酸盐缺乏导致的终末期骨病。由于维生素 D 缺乏症的发病率不断上升，这种疾病的重要性也随之增加。然而，并非所有的骨质软化症病例都可以通过维生素 D 替代治疗治愈，而且并非所有维生素 D 缺乏的个体都会发展为骨质软化症。尽管过去骨质软化症通常是由吸收不良引起的，但现在营养性缺乏更为常见。此外，最近的文献表明，营养性维生素 D 缺乏性骨质软化症与各种病态肥胖的减重手术有关。骨痛、压痛、肌肉无力和行走困难都是骨质软化症的常见临床表现。诊断性检查包括对维生素 D 状态进行生化评估，在某些情况下还可能包括髂骨活检。在大多数情况下，治疗方法是积极补充维生素 D，如果开始使用抗吸收或合成代谢药物，则需要进行后续活检。
