Osteomalacia

Question 1

Osteomalacia

Answer 1

Softening of the bones secondary to low vitamin D levels

Leads to decreased bone mineral content

(Rickets in children)

Question 2

Causes

Answer 2

Vitamin D deficiency (malabsorption, lack of sunlight, diet)

CKD

Drug induced (anticonvulsants)

Inherited (hypophosphatemic rickets)

Liver disease (cirrhosis)

Coeliac disease

Question 3

Features

Answer 3

Bone pain

Bone/ muscle tenderness

Fractures (especially femoral neck)

Proximal myopathy (waddling gait)

Question 4

Blood results

Answer 4

Low vitamin D levels

Low calcium and phosphate

Raised ALP

PTH may be high (secondary hyperparathyroidism)

Question 5

Xrays

Answer 5

Translucent bands (Looser’s zones or pseudofractures)

Question 6

DEXA scan

Answer 6

Low bone mineral density

Question 7

Treatment

Answer 7

Viramin D supplementation (loading dose often needed initially)

Calcium supplementation if dietary calcium inadequate

Question 8

NICE regimes

Answer 8

50000 IU once weekly for 6 weeks

20000 IU twice weekly for 7 weeks

4000 IU daily for 10 weeks

Maintenance dose 800IU per day