Osteomalacia - Background

Question 1

Osteomalacia is inadequate bone ?, usually caused by a ?
? deficiency in adults.
It is characterised by ? pain, bone ? and fractures, however is often
more ? in onset, presenting with ? and general ?.
? is the syndrome resulting from osteomalacia in the growing skeleton,
and these patients develop bone ? in addition to the above features.

Answer 1

mineralisation
vitamin d
bone
fragility
insidious
malaise
weakness
rickets
deformity

Question 2

Full blown osteomalacia is rare in ? countries, but subclinical disease is still common in patients with poor ?, or little ? exposure.
It is often missed as a potential differential in patients with ? ? pain.

Answer 2

dev
diet
sun
chronic widespread

Question 3

Vitamin D (?) can be ingested directly (high levels in oily ?, eggs and fortified ?), but is mostly synthesised from 7-dehydrocholesterol in the ?, providing there is adequate ? ? exposure.
The ? and then ? metabolise the cholecalciferol to form the active metabolite 1,25 -dihydroxycholecalciferol, which normally ? calcium
uptake from the ?, and ? calcium excretion. The resultant ? serum calcium level then stimulates ? secretion.

Answer 3

cholecalciferol
fish
cereals
skin
uv sunlight
liver
kidneys
increases
intestine
decreases
low
PTH

Question 4

The secondary ? acts to stimulate ? bone
resorption, ? calcium excretion and increase ? excretion renally.
The end result of this is progressive ? of calcium and phosphate from the
?, leading to defective ?

Answer 4

hyperPTH
osteoclastic
decrease
phosphate
loss
bone
mineralisation

Question 5

Vitamin D deficiency can thus occur due to many reasons;

0 Inadequate ? intake: rare in the developed world, can occur in ? or patients with ? disease.
0 Inadequate ? of vitamin D: ? patients or ? women
0 Renal disease: ? is associated with osteomalacia.
0 Liver disease: a ? cause.
o ?.

Answer 5

dietary
vegans
malabsorptive
synthesis
housebound
muslim
ckd
rare
drugs

Question 6

Features in the adult will present ?, and many cases will be picked up ?.
As the disease progresses there can be features of ?pain, pathological
? and general ?.
? muscle weakness is prominent, and the patient may walk with a
? gait or experience difficulty ? ?.

Answer 6

insidiously
biochemically
bone
#
malaise
proximal
waddling
climbing stairs