A 33-year-old woman presents with a spontaneous fracture of her femoral head. She has suffered from Crohn disease for 20 years. Multiple surgical procedures have resulted in the removal of much of her small bowel. She has had profound weight loss over the last 10 years. The bone is pinned. Histologically, the resected femoral had shows bony trabeculated that are covered by a thicker–than–normal layer of osteoid (shown in the image). In this section, the osteoid is stained red, and mineralized bone is stained black. Which of the following best describes the pathogenesis of this lesion?
A. Subperiosteal bone resorption
B. Impaired mineralization of osteoid
C. Inflammatory synovium with pannus formation
D. Enhanced osteoblast activity
E. Degenerative changes in the subchondral bone
B. Impaired mineralization of osteoid (osteomalacia)
(this multiple choice question has been scrambled)