SEMINAR

ON
OSTEOMALACIA
BY
SHEELA RAJAKUMARI
MSc NURSING 1ST YEAR
MMM COLLEGE OF NURSING
 INTRODUCTION
• Osteomalacia is a weakening of the bones. Problems
with bone formation or the bone-building process
causes osteomalacia.
• Osteomalacia is derived from Greek: osteo- which
means "bone", and malacia which means "softness". In
the past, the disease was also known as malacosteon.
 DEFINITION

Osteomalacia is defined as a
disease characterized by the softening of the
bones caused by impaired bone metabolism
due to inadequate levels of available
phosphate, calcium and vitamin D, or
because of resorption of calcium.
 CAUSES OF OSTEOMALACIA
The risk of developing osteomalacia is highest
• in people who don't get enough dietary vitamin D
• have little sun exposure,
• such as older adults and those who are housebound
 CAUSES OF OSTEOMALACIA
• VITAMIN D DEFICIENCY -
Sunlight produces vitamin D in your
skin.
• People who live in areas where
sunlight is limited, get little
exposure to sunlight or eat diet low
in vitamin D developes vitamin D
deficiency.
Cont..
• CERTAIN SURGERIES - Normally, the
stomach breaks down food to release calcium
and other minerals that are absorbed in the
intestine.
• This process is disrupted if you have surgery to
remove part or all of your stomach or to bypass
your small intestine and can result in vitamin D
and calcium deficiency.
Cont..
• CELIAC DISEASE - In this autoimmune
disorder, foods containing gluten, a protein
found in wheat, barley and rye, can damage
the lining of your small intestine. A damaged
intestinal lining doesn't absorb nutrients well,
and can lead to vitamin D and calcium
deficiency.
Cont..
• KIDNEY OR LIVER DISORDERS - These
organs are involved in activating vitamin
D in your body. Problems with your
kidneys or liver can affect your body's
ability to make active vitamin D.
Cont..
• DRUGS - Some drugs used to treat
seizures, including phenytoin and
phenobarbital, can cause severe vitamin D
deficiency and osteomalacia.
NORMAL PHYSIOLOGY
 PATHOPHYSIOLOGY
Less exposure to ultraviolet radiation from the sun

Interruption in hydroxylation in liver to form 25-hydroxy vitamin

D

Interruption in hydroxylation in the kidney to form 1,25-

dihydroxy vitamin D

Less activation of vitamin D receptors

Low absorption of calcium to bones

Cont..

Osteomalacia occurs

Pain, tenderness, fracture.

kyphosis.,etc
 SIGNS AND SYMPTOMS OF
OSTEOMALACIA
• Diffuse joint and bone pain (especially of
spine, pelvis, and legs)
• Muscle weakness
• Difficulty walking, often with waddling gait
• Hypocalcemia (positive Chvostek sign)
• Compressed vertebrae and diminished
stature
 Chvostek sign

Chvostek sign is
contraction of facial
muscles provoked by
lightly tapping over the
facial nerve anterior to
the ear
Cont..
• Pelvic flattening
• Weak, soft bones
• Easy fracturing
• Bending of bones
Cont..
• Osteomalacia in adults starts insidiously as aches and pains in the
lumbar (lower back) region and thighs before spreading to the arms
and ribs.
• The pain is symmetrical, non-radiating and accompanied by sensitivity
in the involved bones.
• Proximal muscles are weak, and there is difficulty in climbing up stairs
and getting up from a squatting position.
 DIAGNOSIS
BIOCHEMICAL • Low Serum And Urinary Calcium
FINDINGS • Low Serum Phosphate
• Elevated Serum Alkaline
Phosphate
• Elevated Para Thyroid Hormones
 DIAGNOSIS
RADIOLOGY

X-RAY
• demineralization of bones,
• compressed vertebrae,
• Pseudofracture – also called
looser’s bone
• Protrusio acetabuli – hip joint
disorder
Pseudo fracture Protrusio acetabuli
Bone biopsy
Shows increased
amount of osteoid and a
demineralized cartilaginous
bones are seen.
 MANAGEMENT
• Supplementation of vitamin D – 10,000 IU of vitamin D for 4 – 6
weeks are administred (Inj Arachitol)
• Sun exposure
• Muscle strengthening exercise
COMPLICATION OF
OSTEOMALACIA
FRACTURE
GROWTH DEFORMITY IN CHILDREN
HYPOCALCEMIC SEIZURES
KYPHOSIS AND LORDOSIS
WADDLING GAIT
PROTRUSIO ACETABULI
NURSING MANAGEMENT
THANK YOU