Osteomalacia/Rickets

Glenda Vazquez

Introduction


Osteomalacia is known as the softening of bones due to insufficient vitamin D, or problems with the break down of this vitamin. This disease is also known as rickets in children.Bones with osteomalacia have sufficient amounts of collagen which gives the bones their structure, but they lack calcium. The softness of the bones is more likely to cause bow and fractures.

Causes/Rick Factors


The most common cause of osteomalacia is a deficiency of vitamin D. Vitamin D insufficiency can cause osteomalacia because vitamin D facilitates calcium absorption and other minerals in the gastrointestinal tract necessary for bone building. Lack of vitamin D, calcium and other minerals arent absorbed efficiently, so they are not available for mineralization in the bone building process. This then result in soft bones. Insufficient sunlight exposure Sunlight makes vitamin D in your skin. Therefore osteomalacia can develop in people who spend little time in the sunlight, wear very strong sunscreen, live in areas where sunlight hours are short, or where the air is smoggy. Insufficient vitamin D intake A diet low in vitamin D is the most common cause seen worldwide. Is less common in the U.S. because many foods, such as milk and cereals are fortified with vitamin D. Certain Surgeries The removal of part or all of your stomach known as gastrectomy, can lead to this disease because the stomach breaks down foods to release vitamin D and other materials, which are then absorbed by your intestines. Surgery removing or bypassing your small intestine can lead to osteomalacia. Chronic pancreatitis Pancreatitis is the long-standing inflammation of your pancreas, an organ that makes digestive enzymes and hormones. If the pancreas is inflamed enzymes in charge of breaking down food and releasing nutrients do not flow as freely into your intestines. Chronic sprue In this autoimmune disorder, the lining of the small intestine is damaged by consuming foods having gluten, a protein found in wheat, barley, and rye. Damaged intestinal lining doesnt absorb nutrients, such as vitamin D, as well as a healthy one would.

Incidence/Prevalence

In the United States it is estimated that 20 to 25 million people suffer from osteomalacia, including 25 percent of women beyond menopause Incidence of 1 per 1000 people in the United States Rickets: In the U.S., severe nutritional rickets has become rare, although the mild disorder continues in the high-risk population (eg, individuals with dark skin, persons who live in inner-city areas). Breastfed infants who receive no vitamin D supplementation also are at risk. Rickets: Incidence in Europe is similar to that in the U.S. In sunny areas, such as in the Middle East, rickets may occur when infants are bundled in clothing and are not exposed to sunlight. In some parts of Africa, deficiency of calcium and/or phosphorous in the diet may lead to rickets.

Symptoms/Diagnosis


In the early stages of osteomalacia a person may not feel the symptoms, but may be seen in x-rays or diagnostic tests. As osteomalacia worsens symptoms may include bone pain and muscle weakness. Bone pain is especially felt in the lower spine, pelvis, legs and feet. The pain is dull and aching and get worse with physical activity. Even gentle pressure on the bone may cause severe pain. Osteomalacia may cause weakness and stiffness in the arms and legs, decreased muscle tone and discomfort during movement. Some people also walk with a waddling motion. When diagnosing osteomalacia, doctors will inquire about the patients time spent in the sun and about their diet. In order to rule out other bone diseases the following tests may be conducted: Blood and urine tests In the cases caused by vitamin D deficiency or phosphorous loss, abnormal levels of vitamin D and minerals calcium and phosphorous are often detected through blood and urine tests. X-ray Slight cracks in the bones which are visible on x-rays known as looser transformation zones are characteristic of people with osteomalacia Bone scan Bone scans detect areas of high and low bone metabolism in your body. Radioactive dye is injected in the vein and a picture of the amount of radioactive dye gathers in your bones. Those with osteomalacia have radioactive dye unevenly distributed in some areas of their bones. Bone biopsy A bone biopsy is performed by inserting a slender needle through the skin and into the bone to withdraw a small sample, which is then viewed under a microscope. Even though bone biopsies are very accurate in detecting osteomalacia, it is often not needed to make the diagnosis.

Treatment
Before After

 

When osteomalacia is caused from a dietary or sunlight deficiency, replenishing the low levels of vitamin D in the body usually cures the condition. Doctors also recommend vitamin D supplements depending on the dose needed and whether you have other health problems. Most people with osteomalacia take vitamin D supplements by mouth for several weeks or months. Although uncommon, vitamin D can also be given as an injection or through a vein in the arm. If the blood levels of calcium and phosphorous are low the patient may also take supplements of these minerals. After a patient begins treatment, they may undergo periodic blood tests to assure blood levels of vitamin D and certain minerals are within normal limits. X-rays are also taken to determine the improvement of the bones. Symptoms may lessen within a few weeks of treatment. Doctors suggest that patients continue taking vitamin D indefinitely to prevent the return of osteomalacia.

Prevention
 

Osteomalacia caused by inadequate sun exposure and a diet low in vitamin D can be prevented. Spend a few minutes in the sun Direct exposure in the sun to the arms and legs for five to ten minutes daily is sufficient for adequate vitamin D production. If a person lives in cold climate and dont get enough sun exposure during the winter, they can build enough vitamin D stores in the skin during warmer months. Although regular use of sunscreen helps prevent skin cancer and premature aging of the skin, there is concern that the frequent use of strong sunscreen can increase the risk of developing ostemalacia. Eat food high in vitamin D Eat foods that are naturally rich in vitamin D such as oily fishes (salmon, mackerel, and sardines) and egg yolks. Other foods that are fortified with vitamin D include cereal, bread, milk, and yogurt. Take supplements If a person doesnt get enough vitamins and minerals in their diet or if they have a medical condition affecting the ability of their digestive system to absorbing nutrients, they are recommended to ask a doctor about taking vitamin D and calcium supplements. Exercise Exercise such as walking helps strengthen bones, but if a patient has slight fractures due to osteomalacia, they should avoid strenuous activity until their bones heal.

Questions
1. Osteomalacia is known as the softening of bones due to insufficient vitamin D, or problems with the break down of this vitamin. A) True B) False 2. The most common cause of osteomalacia is ____. A) Vitamin D deficiency B) Lack of collagen C) Excess Vitamin D D) None 3. The softness of the bones is more likely to cause bow and fractures. A) True B) False 4. Osteomalacia can develop in people who a lot little time in the sunlight. A) True B) False