Metabolic bone disease: bone biopsy in osteomalacia: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Metabolic bone disease: bone biopsy in osteomalacia

Sample item

A transiliac bone biopsy after double tetracycline labelling is performed to confirm osteomalacia. Which finding is expected?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Widened osteoid seams with poorly separated or absent tetracycline labels

Osteomalacia is defined histologically by an excess of unmineralised osteoid with wide osteoid seams and a prolonged mineralisation lag time. Tetracycline labels are smudged, diffuse or absent because mineralisation is slow. Osteoporosis shows normal osteoid with reduced bone mass.

Option by option

  • A. Widened osteoid seams with poorly separated or absent tetracycline labels (correct)

    Correct. Wide osteoid seams and poor tetracycline uptake reflect delayed mineralisation.

  • B. Thin osteoid seams with sharply separated double labels

    Sharply separated double labels indicate normal, brisk mineralisation.

  • C. Increased osteoclasts with tunnelling resorption of trabeculae

    Tunnelling resorption by osteoclasts is typical of hyperparathyroid bone disease.

  • D. Woven bone arranged in a mosaic pattern

    A mosaic pattern of woven bone is typical of Paget disease.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is A, Widened osteoid seams with poorly separated or absent tetracycline labels. Osteomalacia is defined histologically by an excess of unmineralised osteoid with wide osteoid seams and a prolonged mineralisation lag time.

Why is "Thin osteoid seams with sharply separated double labels" not the answer?

Sharply separated double labels indicate normal, brisk mineralisation.

Why is "Increased osteoclasts with tunnelling resorption of trabeculae" not the answer?

Tunnelling resorption by osteoclasts is typical of hyperparathyroid bone disease.

Why is "Woven bone arranged in a mosaic pattern" not the answer?

A mosaic pattern of woven bone is typical of Paget disease.

What concept does this question test?

It tests Metabolic bone disease: bone biopsy in osteomalacia in Orthopaedics. Tetracycline labels are smudged, diffuse or absent because mineralisation is slow. Osteoporosis shows normal osteoid with reduced bone mass.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Metabolic bone disease: bone biopsy in osteomalacia?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.