Good morning everyone, I am Keem Lopez and I’ll be presenting bone disease which are Osteomalacia

and gout. Let’s discuss osteomalacia, osteomalacia is also know as the adult rickets that pertains to
metabolic bone disease which is associated with inadequate mineralization of the bone, specifically
calcium, phosphorus, and vitamin D. These three are very important in building healthy bones. So if
there is inadequate mineralization, this will lead to softening and weakening of the bone.

For the etiology, we have 3. The first one is the lack of mineral due to poor dietary intake. Also, patients
might not having enough exposure to sunlight in order to get Vitamin D. The second one is the prolonged
used of medication such as the phenytoin and phenobarbital which disrupts the Vitamin D metabolism
in the liver. The phenytoin is used for seizure. Another medication is antacids bind with phosphates and
corticosteroid with decreased intestinal calcium absorption.

Incidence, this bone disease is dominant in women and multipara. Why women? Since women undergo
menopausal stage, the estrogen decreases, the estrogen contributes an important role in making healthy
bones. On the other hand, multipara women is also one because the mother and the child inside the
womb shares the Vit D, so if the mother fails to get enough vitamin D, calcium, and phosphorus, there’ll
be a problem.

For the signs and symptoms, gait changes, joint and bone pain, fractures, and muscle pain and weakness
are present.

For the anatomy, ill be focusing in the spongy bone and compact bone. Spongy bone is also called
cancellous or trabecular bone which is found in the long bones and surrounded by compact. Compact
bone also known as cortical bone, surrounds spongy bone. they are heavy and tough and compact in
nature.

Next is the pathophysiology. Since the patient have poor dietary intake of calcium, phosphorus and
vitamin D. there’ll be a decrease in the absorption of calcium from the intestine. Let’s be reminded that
Vitamin D is necessary in order to easily absorbed the calcium in our body. Next, there’ll be having an
inadequate concentration of calcium and phosphate in the body fluids because vitamin D is not to
activate the absorption of these two in the body. Since these mineralization is not enough there’ll be an
abnormal mineralized bones leading to decrease skeletal strength and softening and decalcification of
bones, next there’ll be pain and tenderness; generalized weakness due to impaired oxygen delivery to
muscle for decrease RBC. Since there is not enough for healthy and strong bone mineralization, bones
become bent and flattened, in spina-scoliotic and kyphotic deformity, compression fracture bowing and
bending of the long bones.

Diagnostic tests include blood and urine test, x-rays, and bone biopsy. Blood test is used to check the
levels of calcium and phosphorus in the patient’s body. Urine test is used in order to check the how
much levels of the calcium and phosphorus excrete outside the body Bone x-rays and a bone density test
are used to visualize and can help detect pseudofractures, bone loss, and bone softening. Delayed or
inadequate mineralization of the osteoid matrix, demonstrated by bone biopsy (the gold standard
diagnostic tool), which produces bone rarefaction and osseous deformities, classically describes this
lesion.

For medical management, vitamin d, calcium, and phosphate supplement is being given in order to help
the body to create healthy bones. For surgical management, Corrective osteotomy and fixation with
external fixators, Kirshner's wires, intramedullary nail, plates and casting including epiphysiodesis are
being given. For nursing management, we need to encourage patient to have diet rich in vitamin D and
calcium this includes dairy foods like milk, yoghurt and cheese, calcium fortified foods (such as soy
products) and, to a lesser degree, some leafy green vegetables and nuts and seeds, get enough exposure
of sunlight. Avoid smoking and alcohol. Since there is softening of the bone, patient is advised to exercise
regularly and maintain a healthy weight.

 Gout is also known as gouty arthritis is a disease in which acute attacks of arthritis pain occur because
of elevated levels of serum uric acid.
 During acute gout attacks, joint inflammation is caused by sodium crystals in the joint.
 Can be controlled with meal and changes in diet

ETIOLOGY

Genetic predisposition

According to a study, The heritability rate for gout falls between 45% and 73%. 4 Gout tends to
affect multiple family members, and about 20% of people with gout will have family members
with the condition. 5 Your risk is even greater if you have a first-degree relative (a parent or
sibling) with the condition.

Research links gout to an increased risk of several types of

cardiovascular disease, including heart attack, heart failure, and atrial
fibrillation, or an irregular heartbeat.

Dietary factors
 Alcohol. ...
 Organ meats. ...
 Game meats. ...
 Certain seafood, including herring, scallops, mussels, codfish, tuna, trout and
haddock.
 Red meats, including beef, lamb, pork and bacon.
Incidence , mas prominent in males aging between 20 to 40 years old. One of the primary risk factors
for gout is simply being male. Men typically have higher levels of uric acid in their bodies than
women. Therefore, they're closer to hyperuricemia to begin with, making them more susceptible
to attacks when they experience other risk conditions.

Male 2.5–7.0 mg/dL 1.5–6.0 mg/dL

Signs and symptoms

1. Acute periodic episodes of joint pain, swelling and inflammation (usually at NIGHT)
2. Swollen joint
 affect metatarsophalangeal joint of great toe
3. Histologic examination
 Presence and formation of TOPHI in soft tissue

TOPHI

 A nodular deposit of sodium acid urate crystals associated forming in body

Anatomy

JOINT

is an articulation between two bones in the body and are broadly classified by the tissue which
connects the bones. The three main types of joints are: synovial, cartilaginous and fibrous.

synovial cavity

is filled with synovial fluid. The joint capsule is made up of an outer layer of fibrous membrane,
which keeps the bones together structurally, and an inner layer, the synovial membrane, which
seals in the synovial fluid.

1. TENDON TRANSPLANT
 Form a normal muscle to another location to assure the function of damaged tendons
2. OSTEOTOMY
 Cutting bone to correct bone or joint deformity
3. SYNOVECTOMY
 Removal or synovial membrane to prevent recurrent inflammation
4. ARTHROPLASTY
 One part of a joint is replaced
5. TOTAL HIP REPLACEMENT
 Head of femurs the acetabulum are placed
6. TOTAL KNEE REPLACEMENT
 Bone articular knee is replaced
7. INTERPHALANGEAL JOINT REPLACEMENT
OSTEOMALACIA AND GOUT

Osteomalacia is also known as____________.

1. ADULT RICKETS

This bone disease is mostly seen in what gender?

2. (Incidence) Women

Give signs and ymptoms of your answer in number 1

4-5. (Signs and symptoms)

Give its diagnostic tests

6-7. (Diagnostic Tests) Blood and urine test

is a disease in which acute attacks of arthritis pain occur because of elevated levels of serum uric acid.
8. Gout

Give the medications given to patients who have bone disease based on what you have answered in
number 8.

9-10. (Medications) Colchicine, corticosteroids

Give its surgical interventions

11-12. (Surgical interventions) osteotomy, arthroplasty

It is one of the surgical interventions that refers to forming of a normal muscle to another location to assure
the function of damaged tendons

13. Tendon transplant

Give the nursing management based on what you have answered in number 8.

14-15. Increase in fluid, restricting of dietary purine