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O P Kapoor
Ex. Hon. Visiting Physician, Jaslok Hospital and Bombay Hospital, Mumbai,
Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.

As medical students we were taught that osteomalacia was diagnosed by spotting ‘Looser’s Zones’ on the X-rays of the pelvis.

In private practice this is too late to make a diagnosis. In young women complaining of the aches in the back, legs and thighs, the diagnosis should be confirmed not by getting serum calcium levels done (which will also fall much later in the disease) but by asking for the following blood tests:

1. Serum alkaline phosphatase (labile fraction) rises in osteomalacia.

2. Vitamin D blood levels are being done in the laboratories and fall in the levels can be demonstrated.

3. Parathyroid hormone (PTH) is the earliest to rise before the other blood tests become positive. Though it is a costly test, if the PTH (intact) levels could be available, it would be the most accurate method to diagnose early osteomalacia.


I am thankful to Dr. Sanjeev Amin for sharing his experience.

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