OSTEOMALACIA

Osteomalacia (METABOLIC BONE

DISEASE) is a disorder of bone that results
from hypomineralization following the
cessation of bone growth.
rickets, which affects mineralization of
growing bones, osteomalacia does not
affect the growth plates BUT
hypomineralization of trabecular and cortical
bone occurs.
Normal bone mineralization depends on
interdependent factors that supply adequate
calcium and phosphate to the bones.
Vitamin D maintains calcium and phosphate
homeostasis through its action on bone, the
GI tract, kidneys, and parathyroid glands.
Vitamin D may be supplied in the diet or
produced from a sterol precursor in the skin
following exposure to ultraviolet light.
Sequential hydroxylation then is required to
produce the metabolically active form of
vitamin D.
VITAMIN D METABOLISM
Hydroxylation occurs first in the liver and
then in the kidneys to produce 1,25-
dihydroxyvitamin D3.
Dysfunction in any one of these metabolic
steps may result in rickets and osteomalacia
in the growing child, as well as osteomalacia
and secondary hyperparathyroidism in the
adult


CAUSES
Insufficient sunlight exposure, especially in dark-
skinned subjects
Insufficient nutritional quantities or faulty
metabolism of vitamin D or phosphorus
Renal tubular acidosis
Malnutrition during pregnancy
Malabsorption syndrome
Chronic renal failure
Tumor induced osteomalacia
Celiac disease
Clinical features
aches and pains in the lumbar (lower back)
region and thighs, spreading later to the
arms and ribs.
Pain is non-radiating, symmetrical, and
accompanied by tenderness in the involved
bones.
Proximal muscles are weak, and there is
difficulty in climbing up stairs and getting up
from a squatting position.
Due to demineralization bones become less
rigid, physical signs include deformities like
triradiate pelvis and lordosis
Patient may have Trendelenburg gait
Radiographs:
Looser's zones(pseudofractures) radiolucent
zones occuring at sites of stress like pubic rami
axillary border of scapula, ribs

the radiographic appearance of osteomalacia may
be normal or similar to findings noted with
osteoporosis
Laboratory investigations
- hypocalcemia
hypophosphatemia
renal osteodystrophy- phosphorus level is
invariably high & calcium level will be quite
low
ALP elevated
TREATMENT
VITAMIN D 400 I.V DAILY
Calcium supplements
Treat the underlying cause