**8.5 Osteomalacia**

Patients with osteomalacia usually demonstrate similar features of a bone scan as described in hyperparathyroidism, although in the early stages of the disease it may appear normal (Cook et al., 2010). The reason that osteomalacia shows these features is not fully understood. Tracer avidity may reflect diffuse uptake in osteoid, although more likely, it is due to the degree of secondary hyperparathyroidism that is present. In addition, the presence of focal lesions may represent pseudofractures or true fractures. Pseudofractures are characteristically found in the ribs, the lateral border of the scapula, the pubic rami, and the medial femoral cortices. Although osteomalacia is usually a biochemical and*/*or histologic diagnosis, the typical bone scan features can be helpful in suggesting the diagnosis. The detection of pseudofracutures with this technique is more sensitive than that with radiography (Cook et al., 2010; as cited in Fogelman et al., 1977, 1978).
