Osteomalacia and Rickets Flashcards

1
Q

underlying problem

A

insufficient vitamin D leads to defective bone mineralisation

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2
Q

presentation of osteomalacia

A

weak bones
bone pain
muscle weakness
pathological fractures

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3
Q

how is vitamin D made?

A

from cholesterol by the skin in response to UV radiation

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4
Q

groups vitamin D deficiency is more common in

A

darker skin
reduced sun exposure
malabsorption eg IBD
chronic kidney disease

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5
Q

What is vitamin D essential for?

A

calcium and phosphate absorption from intestines and kidneys
bone turnover regulation

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6
Q

inadequate vitamin D does what to calcium and phosphate?

A

lack in the blood

low levels lead to defective bone mineralisation

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7
Q

what does low calcium result in?

A

secondary hyperparathyroidism

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8
Q

hyperparathyroidism

A

parathyroid hormone tries to raise calcium level

increased reabsorption from bones

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9
Q

Lab investigation for vitamin D

A

serum 25-hydroxyvitaminD

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10
Q

other investigations and their findings

A
serum calcium and phosphate low
serum alkaline phosphatase may be high 
parathyroid hormone may be high 
x-rays may show osteopenia
DEXA - low mineral density
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11
Q

treatment

A

vitamin D
50 000IU once weekly for 6 weeks - initial
800 IU maintenance dose

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12
Q

what foods are a source of vitamin D?

A

eggs
oily fish
fortified cereals
nutritional supplements

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13
Q

hereditary rickets

A

rare
x linked dominant
low phosphate

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14
Q

rickets symptoms

A
lethargy 
bone pain 
swollen wrists
bone deformity 
poor growth 
dental problems 
muscle weakness 
pathological fractures
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15
Q

bone deformities in rickets

A
bowing legs
knock knees 
rachitic rosary 
craniotabes 
delayed teeth
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16
Q

What is required to diagnose rickets?

A

x-ray

17
Q

rickets additional investigations for other pathology

A
FBC, ferritin 
ESR, CRP
Kidney and liver function 
thyroid function - hypo
manalbsorption = anti-TTG
autoimmune and rheumatoid
18
Q

Are breast fed or bottle fed babies at higher risk?

A

bottle fed

19
Q

vitamin D supplements for children

A

400 IU/10micrograms per day

20
Q

treating rickets

A

vitamin D and calcium supplements