By: A.Taskin ( 4th year medical student at Sulaiman Al-rajhee colleges )

1. OSTEOMALACIA &
RICKETS
Abdullah
Taskeen

2. DIFINATION :
Rickets :
osteopenia with disordered calcification leading to higher
proportion of osteoid (unmineralized) tissue prior to
epiphyseal
closure (in childhood)
osteomalacia :
osteopenia with disordered calcification leading to higher
proportion of osteoid (unmineralized) tissue after
epiphyseal
closure (in adulthood)

3. BASIC:
Bone consists of :
A- a hard outer shell (cortex) made up of
minerals, mainly calcium and phosphorus,
B- a softer inner mesh (matrix) made up of
collagen fibres.

5. WHEN NORMAL BONE IS
FORMED :
A - these fibres are coated by mineral (this process is
called mineralisation).
B - The strength of the new bone depends on enough
mineral covering the collagen matrix.
The more mineral laid down, the stronger the bone.

6. OSTEOMALACIA HAPPENS :
A. if mineralisation doesn’t take place properly.
B. bone is made up of collagen matrix without a
mineral covering,
C. so the bones become soft.
D. These softened bones may bend and
crack, and this can be very painful.

7. AGAIN !! DIFINATION :
Rickets :
osteopenia with disordered calcification leading to higher
proportion of osteoid (unmineralized) tissue prior to
epiphyseal
closure (in childhood)
osteomalacia :
osteopenia with disordered calcification leading to higher
proportion of osteoid (unmineralized) tissue after
epiphyseal
closure (in adulthood)

8. ETIOLOGY AND
PATHOPHYSIOLOGY
A. Vitamin D Deficiency
B. Mineralization Defect
C. Phosphate Deficiency

10. CLINICAL PRESENTATION :

12. INVESTIGATION :

13. OTHERS :
Serum 25OHD =
low ( exept in V. D resistance rickets )
Serum fibroblast FGF-23 =
 elevated in tumor associated osteomalcia

14. RADIOLOGIC FINDINGS
- pseudofractures,
‘Looser’s zones’
- Linear areas of low density surrounded
scleroticborders.
by
- loss of radiologic distinctness of vertebral bod
trabecula,
- concavity of the vertebral bodies

15. Looser
Zones

16. Looser
Zones

17. diffuse osteopenia and several insufficiency stress fractures
of the bilateral ribs (arrows) and scapulae
Stress fracture

18. several insufficiency stress fractures in the right femoral lesser
trochanter, both femoral necks (arrows), acetabula
(arrowhead), and pubic rami (white arrow).
Stress fracture

19. GOLD STANDARD
Bone biopsy :
A. Increased osteoid width (> 15
μm),
B. increased mineralization lag time, and
C. lack of Uptake of double tetracycline

20. ostoid ( pink ) > 80 %
Ostoid thickness > 12 um
Mineralization lag time > 100 days

21. RX:
- depends on the underlying cause
• vitamin D supplementation
• PO4 supplements if low serum PO4 is present
• Ca supplements for isolated calcium deficiency
• bicarbonate if chronic acidosis

22. RX :
calcitriol or alfacalcidol
there is defective 1α-hydroxylation,

e.g. chronic kidney disease, vitamin D dependency
and hypophosphataemic rickets with osteomalacia.

23. REFERENCES :
Kummar & clarck 7th edition
MD- consult
Good bye !!