OSTEOMALACIA

BY: DR MEHRUNNISA UMAR ASSISSTANT PROFESSOR DEPARTMENT OF MEDICINE

OSTEOMALACIA
T is characterized by inadequate mineralization of

bone matrix due to either:

Vitamin D deficiency, Resistance to vitamin D or

Hypophosphatemia

AETIOLOGY
Vitamin D defciency

- Inadequate sunlight exposure - Low dietry intake - Malabsorption .Celiac disease . Intestinel Resection . Chronic Cholestasis (PBC)

 Renal Disease

- Chronic renal failure - Renal osteodystrophy - Bone disease due to dailysis - Tubular disorders (RTA, Fanconis syndrome)
Miscellaneous

- Multiple Myeloma - Vitamin D dependent rickets - X linked hypophosphatemia (vit D resistant rickets) - Mesenchymal Tumors - Bisphosphanate therapy - High Flouride in water

Clinical Features

Vague Symptoms
Bone or muscle pain or tenderness Fractures are rare.

Proximal Myopathy
Waddling gait Deformity is uncommon in adults

Occassionally, Tetany or hypocalcemic features.

Investigations
Inc. Alkaline phosphatase

Plasma calcium is low or Normal

Serum Phosphate may be low Serum 25- Hydroxyvitamin D3 usauallt LOW X-Rays:

- May be normal or - Show LOOSERS ZONE with linear areas of low density surrounded by sclerotic borders. Iliac Crest Biopsy:with double tetracycline labelling s occassionally necessary

 X-Rays:

- May be normal or - Show LOOSERS ZONE with linear areas of low density surrounded by sclerotic borders long bones and pelvis
Iliac Crest Biopsy:with double tetracycline labelling

is occassionally necessary.

PTH levels are elevated.

Treatment
Correction of Cause

Increase dietry calcium and Vitamin D

Improve Sunlight Exposure Vitamin D replacement:

-Replacement doses (400-800 IU daily) .nutritional deficiency -Pharmacologic doses(40,000-100,000 IU) . In patients with: . Gastrectomy, . Malabsorption, . Liver Disease . Hypoparathyroidism

Prevention
Balanced Diet

Adequate exposure to sunlight

Dietry vit D supplementation in high risk

individuals or communities.

THANK YOU Any Questions?????