Osteomalacia

Musculo-skeletal system;osteomalacia simplified version; easy to read and capture it's content.I hope u all get benefited by the content.

1. 0STEOMALACIA Ms.Shanmugapriya.S Bsc.,Nursing

2. X ray .

3. Introduction Osteomalacia also known as adult rickets,is a disease in the bone becomes abnormally soft because of a disturbed calcium and phosphorus balance secondary to vit-D deficiency,resulting in marked deformities of the weightbearing bones and pathologic fractures.

4. Definition Osteomalacia is a metabolic bone disease characterised by inadequate mineralisation of bone.As a result the skeleton softens and weakens,causing pain,tenderness to touch,bowing of bones and pathologic fractures.

5. Etiological factors VITAMIN D DEFICIENCY: classical-lack of sunlight exposure poor diet gastrointestinal diseases FAILURE OF 125 VITAMIN D SYNTHESIS chronic renal failure vitamin d resistant rickets type 1

6. # VITAMIN D RECEPTOR DEFECTS: * Vitamin D resistant rickets type 1 # DEFECTS IN PHOSPATE AND PYROPHOSPHATE METABOLISM: * Hypophosphatemoic rickets * Autosomal recessive phospatemic rickets * Autosomal dominant phosphatemic rickets * Tumor induced hypophosphatemic osteomalacia # IATROGENIC AND OTHER CAUSES: * Biphosphonate therapy * Aluminium * Floride

7. Due to etiological factors such as, Renal failure GI disorders Deficiency in vitamin D Acidosis Poor absorption of fat and fat soluble vitamins To maintain homeostasis, body uses serum calcium and activates ph

8. Ph stimulates the release of skeletal calcium Poor absoption of calcium in intestine Increased excretion of calcium in faeces Increased excretion of phosphate in urine Decreased calcium level

9. Demineralisation of bone Bony fibrosis and bone cyst formation

10. Clinical manifestation Bone pain Tenderness Muscle weakness from calcium deficiency Waddling or limping gait Pathological fractures Softened vertebrae become compressed,shortening patient’s trunk and deforming thorax Muscle hypotonia

11. Weakness and unsteadyness,presenting risk of falls and fractures Craniotabes Bossing of frontal and parietal bones Delayed anterior frontal closure Enlargement of epiphysis

12. Assesment and diagnostic findings X ray studies Study of vertebrae may show a compression fracture with indistinct vertebral end plates Laboratory studies show low calcium level and phosphorus level and a moderately elevated ALP Urine excretion of calcium and creatinine is low

13. Bone biopsy demonstrates an increased amount of osteiod,a demineralised,cartilagious bone matrix that is sometimes refered to as prebone Routine biochemical screen with measurement of serum 25(OH)D levels are low or undetectable and PTH is elevated. Radiographic osteopnea is common and the presence of vertebral crush fractures may cause confusion with osteoporosis. Radionuclide bone scan can show multiple hot spots in the ribs and pelvis at the site of fractures and the appearance may be mistaken for metastates

14. Medical management Dietary modifications(eg.vitamin D and calcium supplementsetc.,) Exposure to sunlight may be recommended Diet with adequate calcium and protein is necessary Long term monitering is undertaken to ensure stabilization or reversal

15. Surgical management Orthopedic deformities may be treated with braces or surgery-osteotomy

16. Nursing management Vitamin D administered daily until signs of healing takes place Adequate intake of calciom and phosporusas well as protein should be ensured Supplemental calcium in the form of lactate or gluconate is administered Administration of 2000-10000IU of vit-d cholecalciferol by orally.