Osteomalacia

استئومالاسیا

1. Osteomalacia Present by Sajjad Moradi PhD student of nutritional sciences School of Nutrition & Food sciences Isfahan University of Medical Sciences(IUMS) 1

2. Preface Introduction Risk Factors Pathophysiology Symptoms Diagnosis Treatment 2

3. Introduction Osteomalacia is the general term for the softening of the bones due to defective bone mineralization In children is known as rickets It is often restricted to the milder, adult form of the disease 3 Nicholas et al 1963, Osteoporosis, osteomalacia , and the skeletal system. JBJS 45 (2):391-405

4. Introduction Rickets refers to the changes caused by deficient mineralization at the growth plate Osteomalacia refers to impaired mineralization of the bone matrix Rickets & osteomalacia usually occur together as long as the growth plates are open; only osteomalacia occurs after the growth plates have fused. 4 Whyte MP, Thakker RV (2005) Rickets and osteomalacia . Medicine 33 (12):70-74

5. Risk Factors Malnutrition Malabsorption / Postgastrectomy Darker skin more susceptible Renal defects Decreased solar exposure Geriatric patients Medications 5 Hazzazi et al(2013 ) Clinical presentation and etiology of osteomalacia /rickets in adolescents. Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia 24 (5):938-941

6. Pathophysiology 6 A worski Z (1972) Pathophysiology, diagnosis and treatment of osteomalacia . The Orthopedic Clinics of North America 3 (3):623

7. Symptoms Bone pain , backache Muscle weakness Vertebral collapse: kyphosis loss of height Deformities & stress fractures 7

8. Osteomalacia in adults starts insidiously as aches and pains in the lumbar region , spreading later to the arms and ribs Pain is non-radiating, symmetrical, and accompanied by tenderness in the involved bones Proximal muscles are weak 8 Symptoms

9. 9 Symptoms Physical signs include deformities like lordosis Looser zone B iconcave vertebra Spontaneous fractures

10. Symptoms 10

11. Symptoms Rickets  Tetanus , convulsions, failure to thrive M uscular flaccidity Flattening of skull Thickening of wrists from epiphyseal overgrowth, Stunted growth, Rickety rosary, spinal curvature, Coxa vara, bowing 11 Glorieux FH, Chabot G, Tau C Familial hypophosphatemic rickets: pathophysiology and medical management. In: Rickets. Nestle Nutrition Workshop Series, 1991. pp 185-199

12. Diagnosis Comparison of bone pathology   Condition Calcium Phosphate Alkaline phosphatase Parathyroid hormone Comments Osteopenia unaffected unaffected normal unaffected decreased bone mass Osteoporosis unaffected unaffected elevated unaffected thick dense bones also known as marble bone Osteomalacia  and  rickets decreased decreased elevated elevated soft bones 12 Yasuda Y, Kaleta J, Brömme D (2005). "The role of cathepsins in osteoporosis and arthritis: rationale for the design of new therapeutics". Adv. Drug Deliv . Rev. 57 (7): 973–93. doi:10.1016/j.addr.2004.12.013. PMID  Meunier , Pierre (1998). Osteoporosis: Diagnosis and Management. London: Taylor and Francis. ISBN 1-85317-412-2.

13. Diagnosis 13

14. Diagnosis 14

15. Diagnosis 15 Biconcave vertebra

16. Diagnosis 16 Coxa vara Rickety rosary Muscular flaccidity Flattening of skull

17. Treatment 17 Type I – active vitamin D metabolites, 1-alpha hydroxyvitamin D (1-2 microgram daily) or 1,25(OH)2D (0.25-1.5 microgram daily orally), with or without calcium supplements Type II – sometimes responds partially to very high doses of active vitamin D metabolites & calcium and phosphate supplements.

18. Treatment 18 Renal rickets and osteomalacia They occur in patients with chronic renal failure due to: Defects in synthesis of 1,25(OH)2D3 Over treatment with oral phosphate binders Treatment 1-alpha hydroxylated vitamin D Dietary restriction of foods with high phosphate content (milk, cheese, eggs) Phosphate-binding drugs (calcium carbonate, aluminum hydroxide) Pathogenesis, diagnosis and management of osteomalacia Jennie Walker. doi : 10.7748/nop.26.6.32.e593

19. Treatment 19 Hypophosphatemic rickets and osteomalacia Causes Inherited or acquired defects in renal tubular phosphate reabsorption Tumours that secrete phosphaturic substance Clinical features & diagnosis Hereditary disorders present as rickets. The diagnosis is made on the basis of the presence of hypophosphatemia with renal phosphate wasting in the absence of vitamin D deficiency. Tumour -induced disorder presents with severe , rapidly progressive symptoms in patients with no obvious predisposing factor for osteomalacia. Pathogenesis, diagnosis and management of osteomalacia Jennie Walker. doi : 10.7748/nop.26.6.32.e593

20. Phosphate supplements (1-4g daily) + active metabolites of vitamin D (to promote intestinal calcium and phosphate absorption) Tumour -induced osteomalacia is treated in the same way + surgical excision of the tumour 20 Treatment Pathogenesis, diagnosis and management of osteomalacia Jennie Walker. doi : 10.7748/nop.26.6.32.e593

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