Pseudofractures in the absence of osteomalacia

The presence of bilateral pseudofractures is generally considered a reliable radiologic diagnostic feature of osteomalacia. We report two women with long-standing bilaterally symmetrical femoral pseudofractures that did not demonstrate the histologic features of osteomalacia upon examination of non-decalcified sections of iliac crest bone. One patient treated empirically for osteomalacia developed evidence of early vitamin D intoxication. We conclude that there is no completely reliable non-invasive diagnostic test for osteomalacia.