Osteomalacia and vitamin D deficiency
Who to test for vitamin D deficiency under Australian MBS rules, the 50 nmol/L target and how to replace, and recognising osteomalacia (bone pain, proximal myopathy, high ALP, low phosphate, Looser zones) including phosphate-wasting causes such as ferric carboxymaltose, XLH and tumour-induced osteomalacia.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Vitamin D deficiency is common in Australia (about 1 in 4 adults below 50 nmol/L, more in winter and in the south). Most people need no test, just sun-safe exposure or a supplement if at risk.
- Osteomalacia is defective mineralisation of new bone (rickets before growth plates fuse). It causes bone pain, proximal weakness and pseudofractures, and is easily mistaken for osteoporosis, polymyalgia or myopathy.
- Biochemical signature: high ALP, low phosphate, high PTH, with low or normal calcium.
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Sources
- Vitamin D and health in adults in Australia and New Zealand: a position statementAU/NZMedical Journal of Australia (Working group of ANZBMS, Endocrine Society of Australia and Osteoporosis Australia; Nowson et al., Med J Aust 2012;196:686-7), 2012
- MBS item 66833: 25-hydroxyvitamin D quantificationAU/NZAustralian Government Department of Health, Disability and Ageing (MBS Online)
- Vitamin D for the prevention of disease: an Endocrine Society clinical practice guidelineEndocrine Society (Demay et al., J Clin Endocrinol Metab 2024;109:1907-47), 2024
- Global consensus recommendations on prevention and management of nutritional ricketsMunns et al., J Clin Endocrinol Metab 2016;101:394-415, 2016
- Effects of iron isomaltoside vs ferric carboxymaltose on hypophosphatemia in iron-deficiency anemia (PHOSPHARE-IDA)Wolf et al., JAMA 2020;323:432-43, 2020
- Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trialSanders et al., JAMA 2010;303:1815-22, 2010
- Burosumab (PBS Schedule item 13136J, Section 100 Highly Specialised Drugs, Authority Required; XLH and, from 1 August 2026, tumour-induced osteomalacia)AU/NZPharmaceutical Benefits Scheme, Checked November 2026
- Endocrinology (Therapeutic Guidelines)AU/NZTherapeutic Guidelines Ltd
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback