A 62-year-old postmenopausal woman presents with a T-score of −2.8 on DEXA scan. Her serum calcium is 9.2 mg/dL, phosphate 3.5 mg/dL, and alkaline phosphatase is normal. A 58-year-old man with similar bone density loss has a serum calcium of 7.8 mg/dL, phosphate 2.1 mg/dL, and alkaline phosphatase elevated at 95 U/L. Which feature best distinguishes osteoporosis from osteomalacia in this comparison?

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