Bone Scintigraphy and Laboratory Clues to Osteomalacia in a Middle-Aged Man With Hip Fractures

A 43-year-old man with a 1-year history of bilateral hip pain, worsened by standing and walking, presented with a limping gait. x-rays showed diffuse osteoporosis (osteoblastic-lytic), and a bone scan revealed symmetric uptake in the costochondral junctions (rosary beads), femoral neck, proximal tibia, and feet, with no visualization of the kidneys, suggesting a metabolic disorder or neoplasm. Computed tomography revealed osteolytic lesions in multiple bones. Suspecting metabolic bone disease or metastasis, laboratory tests were conducted. Magnetic resonance imaging confirmed bilateral femoral neck fractures. He underwent open reduction internal fixation for the hip fractures. The imaging and laboratory findings suggest osteomalacia.