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Rickets and Osteomalacia: Moderator: Dr. P. Tahbildar
Rickets and Osteomalacia: Moderator: Dr. P. Tahbildar
Rickets and Osteomalacia: Moderator: Dr. P. Tahbildar
20-04-2016
RICKETS AND OSTEOMALACIA
• Inadequate bone
mineralization.
• Excessive
unmineralized
osteoid.
• Osteomalacia adult
version of rickets. Different expression of
• In rickets epiphyseal same disease
involvement.
Pathophysiology
• Deficiency of vit-D
• Hypocalcemia
• PTH secretion
• Plasma Ca
• Plasma P
• Bone resorption
• Bone formation for
compensation, lack of
Ca&P
• Rickets/osteomalacia
Epiphyseal Plate Abnormalities
• Resting & proliferative
zone not affected.
• zone of maturation:
irregularly distributed
cells.
• hypertrophic cells are
irregularly distributed
and the intervening
matrix bars cannot be
identified.
Cont.. • honey comb
pattern vascular
growth distorted.
• Increase cartilage
cells and
unmineralized
matrix increase
length& width of
bones.
• Joint weight
produce “cupping”
NORMAL RICKETS
Cont..
Clinical feature of Rickets and
Osteomalacia
• Failure to thrive, listless,
apathic, irritable,
hypotonia, muscular
weakness etc.
• Delayed milestone.
• Pallid or pasty skin.
• Ligamentous laxity, loose
joint structure.
• Tetany, lareryngeal stridor,
convulsion.
Cont..
• Craniotabes.
• Frontal bossing.
• irregular pits and
grooves of teeth.
• Ricketic rosary,
Harrison’s sulcus,
pigeon chest.
• Rachitic pot belly
abdomen, thoracic
kyphosis (rachitic cat
back).
Cont..
• Skeletal deformity:
• Bow legs
• Knock knee
• Genu varum
• Coxa vera
• Thickening around
wrist, ankle
• Pathological #
X-rays: In rickets,
• Delayed appearance of
epiphyses.
• Thickening & widening
of growth plate.
• Cupping and splaying of
metaphysis.
• Rarefaction & bowing of
diaphysis.
• Bone deformities – Genu
varum, genu vulgum,
coxavera.
X-rays: In osteomalacia,
• Milkman's pseudo
fracture(loosers zone).
• Biconcave vertebrae (from
disc pressure).
• Lateral indentation of
acetabular (trefoil pelvis or
champagne glass pelvis).
• Spontaneous fracture of
ribs, pubic ramii, femoral
neck etc.
• Features of secondary
hyperparathyroidism(
subperiosteal resorption of
bone, brown tumour)
Biochemistry
• Decreased level of serum calcium and
phosphate.
• Increased serum alkaline phosphatase.
• Diminish urinary excretion of calcium.
• Decreased serum level of 25-OH
vitamin D (in vitamin D deficiency
rickets).
• The “calcium phosphate product” < 2.4
Bone biopsy: