How should osteomalacia be diagnosed?

  The disease is best seen in cancellous bones such as the epiphysis and metaphysis of tubular bones, but also in certain flat and irregular bones. According to pathological observation, there are multiple small grayish-white round or oval dense bone masses within the cancellous bone. In addition to the difference in size and number of lesions, the location and imaging and histological manifestations of bone islands and bone speckles are similar, so it is assumed that the mechanisms of occurrence are similar. It is possible that the peripheral lamellar bone is connected to the thickened trabeculae, and that the lamellar bone and trabeculae are not accompanied by slow bone proliferation, but rather by a lack of corresponding bone resorption, resulting in impaired bone remodeling, and that there is an instability at the site of the lesion, i.e., potentially active bone remodeling, based on the pathology that the lesion can disappear or increase in size. However, the disease does not invade the periosteum or articular cartilage, and no inflammation, malignant changes or pathological fractures occur. The literature reports that in children the lesions may become progressively larger as the body grows. In adults, no increase in the lesion is seen on follow-up but the morphology may change slightly, so the disease cannot be excluded from congenital origin.  (1) The disease has no clinical symptoms and is detected during physical examination or examination for other diseases.  (2) The disease is not related to age or sex, and the age of the group ranges from 22 to 58 years old.  (3) The lesions show diffuse multiple round, oval, circle, or nodular shadows with increased density, and their morphology travels, partially in line with the long axis of the bone.  (4) The lesions mostly involve both ends of long bones, densely in the epiphysis and epiphyses, as well as the pelvis, hands, feet and irregular bones. The closer the lesions are to the joints, the more dense they are and the denser they are. The lesions may fuse with each other to form patches and obscure normal bone tissue.  (5) The edges of the dense speckled lesions are not very clear and sharp, and the closer to the center, the denser the lesions are, while the edges are slightly lighter in density.  (6) The lesion invades the cancellous bone of the bone. The periosteum and articular cartilage are not invaded, so the joint space is clear and bright.  (7) ECT examination shows that the radiological distribution of the bones is not uniform after visualization, and there are multiple foci of bone calcification of different sizes in the cancellous bone. Corresponding radioactive enhancement of bone image. According to the above performance, multiple foci of bone metabolism enhancement on the whole body bone image are abnormal bone metabolism.  (8) This disease should be differentiated from osteogenic metastasis. Osteogenic metastases should firstly have primary lesions and metastases are single or scattered multiple foci of bone thickening without intensive symmetry. The lesions are larger in diameter, generally above 1.0 cm in diameter, and are accompanied by obvious pain symptoms. It is not difficult to differentiate from this disease. It should also be distinguished from wax tear-like bone. The main reason for the misdiagnosis of this disease is the lack of awareness of the clinical and radiologic physicians and the failure to think about the possibility of this disease.