Osteomalacia

Question 1

what deficiencies can cause osteomalacia

Answer 1

calcium, phosphate and Vitamin D

most commonly deficiency in Vitamin D

Question 2

what does deficiencies in Ca, PO4 or Vit D cause in bones

Answer 2

bones become softer and therefore fracture more easily

Question 3

what is osteomalacia

Answer 3

Osteomalacia is a metabolic bone disease characterised by incomplete mineralisation of the underlying mature organic bone matrix (osteoid) following growth plate closure in adults

Question 4

what disease in children is caused by the same pathological process

Answer 4

rickets

Question 5

what are the risk factors for osteomalacia

Answer 5

dietary calcium and vitamin D deficiency

chronic kidney disease

malabsorption

limited sunlight exposure

inherited disorders of vitamin D and bone metabolism

Question 6

presenting symptoms of osteomalacia (adults)

Answer 6

Bone pain (typically lower back, pelvis and lower extremities)

Myalgia and weakness (particularly affecting quadriceps and gluteal muscles) and impaired physical function

fractures

waddling gait

Question 7

presenting symptoms of rickets (children)

Answer 7

bowing of the knees, knock knees, wrist swelling, skull softening, delayed tooth eruption, bone pain and muscle weakness

Question 8

what investigations will be done

Answer 8

serum calcium (low) , Vitamin D levels (low), serum phosphate (Low), PTH (high), X-rays

Question 9

typical findings (biochemical) for osteomalacia

Answer 9

low calcium, low phosphate, high PTH, low vit D

Question 10

typical findings (radiological) for osteomalacia

Answer 10

Looser lines (or zones) which are lucencies going part of the way through the bone

Question 11

management of osteomalacia

Answer 11

vitamin D supplementation PLUS lifestyle advice

Question 12

what lifestyle advice to give for patients with osteomalacia

Answer 12

safe sun exposure, dietary intake of vitamin D and calcium, long term maintenance supplements