Osteomalacia and rickets

Question 1

Definition of osteomalacia

Answer 1

It is a metabolic disorder characterized by inadequate mineralization of excess osteoid due to the interference in the calcification mechanism leading to softening of bone

Question 2

Radiological features of osteomalacia

Answer 2

• looser’s zone(pseudofractures)
• codfish spine-biconcave spine
• lateral indentation of acetabula: trefoil pelvis or triradiate pelvis or champagne glass pelvis
• protrusio acetabula
• # of diaphysis of ribs, pubic rami, femoral neck

Question 3

Treatment of osteomalacia

Answer 3

• vit D 400-2000IU

- in case of malabsorption: 50000 IU

Question 4

Define rickets

Answer 4

Metabolic d/o of childhood occurring due to inadequate mineralization of osteoid, prominently affecting the growth plates resulting in the softening of bones and deformities of endochondral skeleton.

Nutritional rickets = 6mnth-2 years

Question 5

Types of rickets

Answer 5

I= due to deficiency or defect in metabolism of vitamin D

II= due to low serum phosphate due to dietary deficiency or defective tubular absorption

Question 6

C/F of rickets

Answer 6

• bone pain during rest
• excessive perspiration in upper half of the body
• infants: hypocalcaemic tetany(chovstek’s sign +ve)
• failure to thrive and waddling gait
• muscular hypotonia-pot belly
• bone changes

Question 7

Bone changes in rickets

Answer 7

> skull
- delayed closure of fontanels, broadened skull, caput quadratum, craniotabes and frontal and parietal bossing

> chest:
- pigeon chest, rickets rosary and harrison’s sulcus

> teeth
- enamel hypoplasia and delayed eruption of tooth

> vertebrae
- exaggerated curvature

> deformities
- knock knees, bow legs or coxa vara and anterior bending of femur

Question 8

Radiological features of rickets

Answer 8

• delayed appearance of epiphysis
• widening of epiphyseal plates due to excessive accumulation of uncalcified osteoid at growth plate
• cupping of metaphysis
• splaying of metaphysis
• rare faction of diaphyseal cortex
• bone deformities

Question 9

T/t of rickets

Answer 9

Single oral dose of vit D 600000 IU

If line of healing ( a line of sclerosis on metaphyseal side of growth plate is not seen on x ray within 3-4 wks then repeat the dose

If respond them 400 IU/day maintenance dose

If still no response refractory

For deformity: splint
Or corrective osteotomy after 6 months of starting treatment