Everyone knows that osteoporosis leads to fractures, especially hip fractures. And almost everyone knows that DEXA scans (now called DXA scans) or other radiographic tests for bone mineral density are used to detect osteoporosis.
However, few people realize that DXA-scans will also detect osteomalacia, the adult form of rickets. The problem is that the doctor always assumes the abnormal calcium content is osteoporosis, rather than raising the question that it might indicate osteomalacia.
DXA-scans tell you nothing about bone quality; they only tell you if you have adequate bone mineralization. DXA scans cannot distinguish between osteoporosis and osteomalacia.
In fact, DXA-scans will only tell you if you have adequate bone calcium. It tells you nothing about the other minerals that bones need, such as magnesium, zinc, boron, copper, manganese, silica, and iron. Of these minerals, the average intakes of magnesium, zinc and boron are likely to be low in the typical American diet.
So how does one detect osteomalacia or adult rickets, if a DXA scan is no good? It is very difficult to test for osteomalacia. Unless it is severe, plain x-rays of bones will be normal.
Osteomalacia is a softening of the bone, making it weak. Under the microscope, osteomalacia is detected by an excess amount of unmineralized osteoid. Osteoid is the protein of bone, it makes up about fifty percent of bone volume and forty percent of bone weight. The predominant protein is collagen, which comprises ninety percent of the osteoid.
So, virtually the only way to detect osteomalacia reliably is by a bone biopsy. That is exactly what Finnish researchers did in 1982; they took bone biopsies of 50 consecutive hip fracture patients.
They found that a startling 24% of these patients had osteomalacia. While osteoporosis was the most common finding, many patients had both osteomalacia and osteoporosis.
An earlier study in the USA found 26% of patients with hip fracture also had osteomalacia.
No one knows what percentage of modern hip fracture patients have osteomalacia. However, I doubt much has changed in 30 years except for increased sun avoidance and thus even more widespread vitamin D deficiency.