osteomalacia

osteomalacia

1. Osteomalacia
Prepare by: RN Arpana Bhusal
BNS

2. Osteomalacia
•Osteomalaciaisageneralizedboneconditioninwhichinadequate
mineralizationofbonematrixresultfromacalciumorphosphatedeficiency
orboth.
•ItissofteningofthebonesduetoalackofvitaminDoraproblemwiththe
body'sabilitytobreakdownandusethisvitamin.
•characterizedbyincompletemineralizationofnormalosteoidtissue
followingclosureofthegrowthplates.
•Whenthenewlyformedbonecontentisdemineralize,thebonysubstanceis
replacedbysoftosteoidtissueosteomalaciaoccurs,andthishappensinall
ages.

3. Osteoids
•BonematrixprimarilycomposedoftypeIcollagen.
•Itdoesnotmineralizeproperlywhenthereinsufficientmineralsor
osteoblastdysfunction.
•Whenthenewlyformedboneofthegrowthplatedoesnot
mineralize,thegrowthplatebecomesthick,wideandirregularand
causericketsinchildren.
•Whentheremodeledbonedoesnotmineralize,osteomalaciaoccurs.

4. Causes:
•Insufficientcalciumabsorptionfromtheintestine—lackof
calciumorresistancetotheactionofvitamminD
•Increasedrenalphosphoruslevel
•Undernutritionduringpregnancy
•MalabsorptionSyndrome
•PartialGastrectomy

5. Risk factors:
•Dietary deficiency (dietary, sunlight)
•Sunlight exposure inadequate
•Malabsorption-celiac disease, chronic biliary tract obstruction,
small bowel resection
•Severe renal insufficiency, liver disease
•Prolonged anticonvulsant therapy

6. Pathogenic Mechanism
•DeficiencyofactivatedvitaminD-promotescalciumabsorptionfrom
GITandfacilitatedemineralizationofbone.
•Lowextracellularsupplyofcalciumandphosphateanddoesnot
movecalcificationsitesIbone.
•Failedcalciumabsorptionorfromexcessissivelossofcalciumfrom
thebody.
•Chronicbilliarytractobstruction,pancreatitisleadtofatinadequately
absorbedandleadtolossofvitaminDandcalciumexcretedwith
fattyacid.
•Liver&KidneydiseaseleadtolackofVitaminDanddoesnotcovert
Inactivatedform.
•Hyperparathyroidismleadstoskeletaldecalcificationandthusto
osteomalaciabyincreasingexcretionofphosphate.

7. Pathophysiology:
Lack of one or more of the factors necessary
for osteogenesis
Defective bone mineralization
Osteomalacia

8. Clinical manifestations:
•Bonepain,tendernessandfracture
•Muscleweakness,waddling(unusual)orlimpinggait
•Difficultyinclimbingupanddownstairs.
•Tetanymaymanifestasacarpopedalspasmandfacialtwitching
•Kyphosis,ribdeformities
•Markedbowingofthetibiaandfemurs
•Delayedhealingorpoorretentionofinternalfixationdevices

9. Diagnosis:
•X-ray-transverselineorpseudofractures(Looser’sZonei.e
pseudofractureatthestresspointcommonatpubicramii,axillary
boarderofscapula,ribs,medialcortexoftheneckoffemur).
•Bonebiopsy(Excessuncalcifiedosteoid)
•Laboratorytest-urine,blood(LowCalcium,LowPhosphate,
Alkalinephosphatasehigh)

10. Treatment of osteomalacia:
Treatmmentdependsoncauses,signsandsymtoms
•Exercise
•CalciumandvitaminD(400IUdaily)suppliment
•RegularBloodtest
SourcesofVit.D
Sunlight:15min.adayissufficientoralternatively,5-15mintosun
exposureatleasttwiceweekly.
Food:VitaminfortifiedfoodproductslikeMilk,orangeJuiceandcereals,
fattyfish,eggyolk,liver.

11. Recommended Vit.D
Age Male Female
0-12 months 400 IU (10mcg) 400 IU (10mcg)
1-13 years 600 IU (15mcg) 600 IU (15mcg)
14-18 years 600 IU (15mcg) 600 IU (15mcg)
19-50 years 600 IU (15mcg) 600 IU (15mcg)
51-70 years 600 IU (15mcg) 600 IU (15mcg)
More than 70 years 800 IU (20mcg) 800 IU (20mcg)

12. Prognosis
•Improvement can be seen within a few weeks in some people with
vitamin deficiency disorders.
•Complete healing with treatment takes place in 6 months.
Prevention
•Diet rich in Vitamin D
•Get sunlight

13. Nursing management:
1.Describediseaseprocessandtreatmentregimen
–Describespecificfactorscontributingtodiseaseprocess
–ConsumestherapeuticamountsofcalciumandvitaminD
–Exposesselftosunlight
–Monitorsserumcalciumlevelregularly
–Keepsfollow-upvisitroutinelyandasnecessary
2..Relievepain-physical,psychologicandpharmaceuticalmeasures
–Handlegentlywhileassistingpatientandavoidunnecessaryand
frequentmovement
–Adviceoruseaconvolutedfoammattressandsoftpillow
–Usediversionalactivities
–Provideanalgesicaccordingtoprescription
–Monitoreffectsofinterventions/painrelief

14. Food sources of Vit D
1 Sources IU /serving
2 Egg 1 large (Yolk) 41
3 Cereals 0.75-1 cup 40
4 Milk non fat 1 cup 115-124
5 Yogurt (6ounce) 80
6 Orange juice 1 cup 137
7 Tuna fish canned in water, drained 3 ounce 154