Osteomalacia & Rickett's

Question 1

What is Osteomalacia

Answer 1

Osteomalacia is a qualitative defect of bone with abnormal softening of the bone due to deficient mineralization of osteoid (immature bone) secondary to inadequate amounts of calcium and phosphorus.

Question 2

What is rickets

Answer 2

Rickets is the same disease occurring in children which has subsequent effects on the growing skeleton.

Question 3

The principal causes of osteomalacia and rickets (3)

Answer 3

insufficient calcium absorption from the intestine =
-lack of dietary calcium

deficiency of or resistance to the action of vitamin D

phosphate deficiency caused by increased renal losses.

Question 4

Specific causes of osteomalacia + rickets (6)

Answer 4

malnutrition (Ca & vit D)

malabsorption (low vit D absorption)

lack of sunlight exposure (no activation vit D)

hypophosphateamia (re‐feeding syndrome, alcohol abuse )

long term anticonvulsant use and chronic kidney disease
(reduced phosphate resorption & failure of activation vitamin D).

renal diseases are inherited disorders
(X‐linked hypophosphataemia or vitamin D resistant rickets).

Question 5

symptoms (4)

Answer 5

bone pain (pelvis, spine and femora)

deformities from soft bones (particularly rickets)

sustain pathological fractures easily

symptoms of hypocalcaemia
(paraesthesiae, musc cramps, irritabil, fatigue, seizures, brittle nails).

Question 6

investigations (4)

Answer 6

Radiographs may also demonstrate pseudofractures (aka Looser’s zones) particularly of the pubic rami, proximal femora, ulna and ribs.

a low calcium

low serum phosphate

high serum alkaline phosphatase.

Question 7

treatment (1)

Answer 7

Treatment involves vitamin D therapy with calcium and phosphate supplementation.