Differential Diagnosis between Bone Metastasis and Osteomalacia to the Patient Undergone Total Gastrectomy for Gastric Carcinoma

We diagnosed a patient who experienced lumbago after total gastrectomy for advanced gastric carcinoma as having bone metastasis of gastric carcinoma, but the diagnosis resulted in osteomalacia. Bone metastasis is diagnosed based on hot spots in bone scintigraphy, low intensity of T1-weighted images and high intensity of T2-weighted images on bone by MRI, the increase of serum alkaline phosphatase, etc. Osteomalacia is linked hot spots in the cost-chondral junction of bone scintigraphy and hypocalcemia. MRI cannot differentiate between bone metastasis and osteomalacia. Osteomalacia after gastrectomy is prevented by sun-bathing, exercise, consuming dairy products, and serum calcium monitoring. In hypocalcemia, it is necessary to take calcium and vitamin D. Because bone metastasis and osteomalacia cannot be differentiated, it is necessary to prevent and treat osteomalacia after gastrectomy.