Osteomalacia Is Not a Single Disease
Abstract
:1. Introduction
2. Physiopathology of Defective Mineralization and Proposed Pathogenetic Classification of Mineralization Disorders
3. Histopathological Features of Osteomalacia
4. Clinical and Radiological Manifestations
5. Biochemical Features and Differential Diagnosis
6. More Frequent Forms of Osteomalacia in Clinical Practice
6.1. Acquired Osteomalacia
6.2. Inherited Osteomalacia
7. Prevention and Treatment
8. Research Gaps and Potential Development in the Field
9. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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1A—Classification of osteomalacia based on response to treatment with vitamin D metabolites. |
Vitamin D-Sensitive Osteomalacia |
Vitamin D deficiency Malabsorption syndromes (e.g., celiac disease, bariatric surgery) Malnutrition (e.g., unbalanced vegan diet) Chronic liver diseases Chronic kidney diseases Drugs interfering with vitamin D metabolism Vitamin D-dependent rickets
|
Vitamin D-Resistant Osteomalacia |
Vitamin D-dependent rickets
|
1B—Classification of osteomalacia based on the time-of-onset. |
Early-onset Rickets/Osteomalacia |
Genetically determined hypophosphatemia
|
Early- or Late-onset Rickets/osteomalacia |
FGF23-dependent
|
1C—Classification of osteomalacia based on the pathogenesis. |
Congenital Osteomalacia |
Genetically determined hypophosphatemia
|
Acquired Osteomalacia |
FGF23-independent
|
ALP | Pi | TmP/GFR | Ca | PTH | 25(OH)D | 1,25(OH)2D | FGF23 | |
---|---|---|---|---|---|---|---|---|
Vitamin D deficiency | =↑ | =↓ | =↑ | =↓ | =↑ | ↓↓ | =↑↓ | =↓ |
Malabsorption syndromes, other nutritional deficiencies | =↑ | =↓ | =↑ | =↓ | ↑/↑↑ | ↓ | =↑↓ | =↓ |
Vitamin D-dependent rickets type 1 | ↑ | ↓↓ | ↑ | ↓↓ | ↑ | ↑↓ | ↓↓ | =↓ |
Vitamin D-dependent rickets type 2 | ↑ | ↓↓ | ↑ | ↓↓ | ↑ | =↑↓ | ↑↑ | =↓ |
Drugs inhibiting mineralization | =↑ | = | = | = | = | = | = | = |
Hypophosphatasia | ↓↓ | = | = | = | = | = | = | = |
FGF23-unrelated hypophosphatemic disorders | ↑ | ↓↓ | =↑ | = | =↑ | = | =↑ | =↓ |
FGF23-related hypophosphatemic disorders | ↑ | ↓↓ | ↓↓ | = | =↑ | = | ↓ | ↑↑ |
Disease | Gene | OMIM Phenotype Number | OMIM Gene Number | Inheritance |
---|---|---|---|---|
| ||||
X-linked dominant hypophosphatemic rickets/osteomalacia (XLH) | PHEX | # 307800 | 300550 | XLD |
Autosomal dominant hypophosphatemic rickets/osteomalacia (ADRH) | FGF23 | # 193100 | 605380 | AD |
Autosomal recessive hypophosphatemic rickets/osteomalacia 1 (ARHR1) | DMP1 | # 241520 | 600980 | AR |
Autosomal recessive hypophosphatemic rickets/osteomalacia 2 (ARHR2) | ENPP1 | # 613312 | 173335 | AR |
Hypophosphatemic disease with dental anomalies and ectopic calcification | FAM20C | # 259775 | 611061 | AR |
Hereditary hypophosphatemic rickets with hypercalciuria (HHRH) | SLC34A3 | # 241530 | 609826 | AR |
McCune–Albright syndrome/fibrous dysplasia (MAS) | GNAS | # 174800 | 139320 | (postzygotic somatic mutations) |
Cutaneous skeletal hypophosphatemia syndrome | NRAS HRAS | # 162900 | 164790 190020 | (somatic mutations) |
| ||||
Fanconi renotubular syndrome 1 (FRTS1) | - | # 134600 | - | AD |
Fanconi renotubular syndrome 2 (FRTS2) | SLC34A1 | # 613388 | 182309 | AR |
Fanconi renotubular syndrome 3 (FRTS3) | EHHADH | # 615605 | 607037 | AD |
Fanconi renotubular syndrome 4 (FRTS4) | HNF4A | # 616026 | 600281 | AD |
Dent’s disease 1 | CLCN5 | # 300009 | 300008 | XLR |
Dent’s disease 2 | OCRL | # 300555 | 300535 | XLR |
Lowe syndrome | OCRL | # 309000 | 300535 | XLR |
| ||||
Vitamin D-dependent rickets/osteomalacia type 1A (VDDR1A) | CYP27B1 | # 264700 | 609506 | AR |
Vitamin D-dependent rickets/osteomalacia type 1B (VDDR1B) | CYP2R1 | # 600081 | 608713 | AR |
Vitamin D-dependent rickets/osteomalacia type 2A (VDDR2A) | VDR | # 277440 | 601769 | AR |
Vitamin D-dependent rickets/osteomalacia type 2B (VDDR2B) | - | # 600785 | - | AD |
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Cianferotti, L. Osteomalacia Is Not a Single Disease. Int. J. Mol. Sci. 2022, 23, 14896. https://doi.org/10.3390/ijms232314896
Cianferotti L. Osteomalacia Is Not a Single Disease. International Journal of Molecular Sciences. 2022; 23(23):14896. https://doi.org/10.3390/ijms232314896
Chicago/Turabian StyleCianferotti, Luisella. 2022. "Osteomalacia Is Not a Single Disease" International Journal of Molecular Sciences 23, no. 23: 14896. https://doi.org/10.3390/ijms232314896