Osteomalacia

Differential Diagnosis I

Osteomalacia is a bone disease which is a result of poor mineralization of the bone. Although the bone volume is consistent, the remodeling of bone results in a soft replacement instead of strong healthy bone. Osteomalacia is primarily caused by a deficiency in vitamin D. The lack of vitamin D decreases plasma calcium concentration, which causes an increase in parathyroid hormone levels.  The secretion of extra parathyroid hormone will cause an increase in plasma calcium concentration, which will cause a decrease in phosphate. The low level of phosphate will cause a disruption in the calcification of bones; subsequently, leading to osteomalacia (McCance & Huether, 2019).

Rationale:

Patient C.S. presents malnourished after a low impact fall resulting in mild injury which could lead to a misdiagnosis of osteomalacia. Considering her clinical presentation and collective history, however, osteoporosis is a more likely diagnosis (McCance & Huether, 2019).  The following table lists common and differing factors with the diagnosis of osteoporosis:

Common Factors	Differing Factors
Right distal radius fracture from a low impact fall Underweight Vitamin D deficiency	Family history Medical history Social history

Giant Cell Tumor

Differential Diagnosis II

A giant cell tumor is a primary type tumor that is ordinarily benign and affects women more frequently than men. The growth of a giant cell tumor is slow, and it generally stays within the originally affected area. The tumor causes widespread resorption which leads to a breakdown of surrounding bone. The radius, humorous, femur, and tibia are the locations most commonly affected (McCance & Huether, 2019).

Rationale:

Patient C.S. is a woman presenting with a distal radial fracture after a low impact fall. The pathophysiology of a giant cell tumor causes the surrounding bone to weaken which can lead to a spontaneous fracture.  In osteoporosis, a trauma often precedes a fracture (McCance & Huether, 2019).  The following table lists common and differing factors with the diagnosis of osteoporosis:

Common Factors	Differing Factors
Right distal radius fracture from a low impact fall Gender	Occurred after low-impact fall

 

Paget’s Disease

Differential Diagnosis III

Paget’s disease may be inherited through the mutation of the sequestosome-1 gene, or preceded by a viral infection. This disease may not present with any clinical manifestations. As a person ages, they have a higher susceptibility of developing Paget’s disease. Most people receive a diagnosis over the age of 40 (McCance & Huether, 2019).

Rationale:

Patient C.S. is a woman over the age of 40 with a distal radial fracture. Paget’s disease affects men more than women with a proportion of 1.8 to 1 and also commonly results in spine, skull, and femur fractures as a result of bone softening (McCance & Huether, 2019).  The following table lists common and differing factors with the diagnosis of osteoporosis:

Common Factors	Differing Factors
Age Fracture	Gender Location of fracture