Osteomalacia

Question 1

Osteomalacia

Answer 1

Osteomalacia

Basics
normal bony tissue but decreased mineral content
rickets if when growing
osteomalacia if after epiphysis fusion

Types
vitamin D deficiency e.g. malabsorption, lack of sunlight, diet
renal failure
drug induced e.g. anticonvulsants (e.g. phenytoin)
vitamin D resistant; inherited
liver disease, e.g. cirrhosis

Features

rickets: knock-knee, bow leg, features of hypocalcaemia
osteomalacia: bone pain, fractures, muscle tenderness, proximal myopathy

Investigation
low calcium, phosphate, 25(OH) vitamin D
raised alkaline phosphatase
x-ray: children - cupped, ragged metaphyseal surfaces; adults - translucent bands (Looser’s zones or pseudofractures)

Treatment
calcium with vitamin D tablets

Question 2

Vitamin D Deficiency and Treatment

Answer 2

Vitamin D deficiency versus insufficiency

Description > Serum levels > Treatment

Adequate vitamin D
>50 nmol/L
Dietary recommendations

Insufficient vitamin D
30-50 nmol/L
maintenance dose vitamin D

Deficient vitamin D
<30 nmol/L
loading dose vitamin D