Osteomalacia--a common disease in elderly women.

Osteomalacia is not generally regarded as a common disease in western countries and the condition consequently receives scant treatment in many of the standard medical textbooks. It is well recognised as a complication of intestinal malabsorption, gastric surgery and renal tubular defects, and most of the cases reported from Europe and the United States fall into these categories. Dietary deficiency of vitamin D has not been regarded as an important cause (Albright, Burnett, Parson, Reifenstein and Roos 1946; Sherman 1950; Salvesen and B#{246}e 1953). ln the past four years we have observed thirty-seven cases of osteomalacia, thirty-one presenting in an orthopaedic and geriatric service in the South-Eastern region of Scotland and six in other regions. Our experience suggests that the disease is in fact quite common, particularly in elderly women. These cases of osteomalacia bear a superficial resemblance to senile osteoporosis and it is probable that the latter diagnosis is too readily accepted. A distinction between these two diseases is very important because treatment is highly effective in osteomalacia but not in osteoporosis. The purposes of this paper are, therefore, to indicate the frequency of osteomalacia and to describe and evaluate some diagnostic features with particular reference to the points which distinguish it from osteoporosis, and to outline the treatment. The thirty-seven cases of our series are reviewed against the background of previously published work in an attempt to assess these aspects of the disease.