استئومالاسیا

1. Osteomalacia
Present by
Sajjad Moradi
PhDstudentofnutritionalsciences
SchoolofNutrition&Foodsciences
IsfahanUniversityofMedicalSciences(IUMS)
1

2. Preface
Introduction
Risk Factors
Pathophysiology
Symptoms
Diagnosis
Treatment
2

3. Introduction Osteomalacia is the general
term for the softening of the
bones due to defective bone
mineralization
In children is known as rickets
It is often restricted to the
milder, adult form of the
disease
3
Nicholas et al 1963, Osteoporosis,
osteomalacia, and the skeletal system. JBJS
45 (2):391-405

4. Introduction Rickets refers to the changes caused
by deficient mineralization at the
growth plate
Osteomalacia refers to impaired
mineralization of the bone matrix
Rickets & osteomalacia usually occur
together as long as the growth plates
are open; only osteomalacia occurs
after the growth plates have fused.
4Whyte MP,Thakker RV (2005) Rickets and
osteomalacia. Medicine 33 (12):70-74

5. Risk
Factors
Malnutrition
Malabsorption / Postgastrectomy
Darker skin more susceptible
Renal defects
Decreased solar exposure
Geriatric patients
Medications
5
Hazzazi et al(2013) Clinical presentation and etiology of
osteomalacia/rickets in adolescents. Saudi journal of kidney
diseases and transplantation : an official publication of the Saudi
Center for OrganTransplantation,SaudiArabia 24 (5):938-941

6. Pathophysiology
6
Aworski Z (1972) Pathophysiology, diagnosis
and treatment of osteomalacia.The Orthopedic
Clinics of North America 3 (3):623

7. Symptoms
Bone pain , backache
Muscle weakness
Vertebral collapse: kyphosis
loss of height
Deformities & stress fractures
7

8. Osteomalacia in adults starts
insidiously as aches and pains in the
lumbar region, spreading later to the
arms and ribs
 Pain is non-radiating, symmetrical,
and accompanied by tenderness in the
involved bones
 Proximal muscles are weak
8
Symptoms

9. 9
Symptoms
Physical signs include deformities like
lordosis
Looser zone
Biconcave vertebra
Spontaneous fractures

10. Symptoms
10

11. Symptoms
Rickets
Tetanus , convulsions, failure
to thrive
Muscular flaccidity
Flattening of skull
Thickening of wrists from
epiphyseal overgrowth,
Stunted growth, Rickety
rosary, spinal curvature, Coxa
vara, bowing
11
Glorieux FH, Chabot G,Tau C Familial hypophosphatemic
rickets: pathophysiology and medical management. In:
Rickets. Nestle NutritionWorkshop Series, 1991. pp 185-199

12. Diagnosis
Comparison of bone pathology
Condition Calcium Phosphate Alkaline
phosphatase
Parathyroid
hormone
Comments
Osteopenia unaffected unaffected normal unaffected decreased
bone mass
Osteoporosis unaffected unaffected elevated unaffected
thick dense
bones also
known as
marble bone
Osteomalacia
and rickets
decreased decreased elevated elevated soft bones
12
YasudaY, Kaleta J, Brömme D (2005). "The role of cathepsins in osteoporosis and arthritis: rationale for the design of new
therapeutics". Adv. Drug Deliv. Rev. 57 (7): 973–93. doi:10.1016/j.addr.2004.12.013. PMID
Meunier, Pierre (1998). Osteoporosis: Diagnosis and Management. London:Taylor and Francis. ISBN 1-85317-412-2.

13. Diagnosis
13

14. Diagnosis
14

15. Diagnosis
15
Biconcave vertebra

16. Diagnosis
16
Coxa vara Rickety rosary
Muscular flaccidity Flattening of skull

17. Treatment
17
 Type I – active vitamin D metabolites, 1-
alpha hydroxyvitamin D (1-2 microgram
daily) or 1,25(OH)2D (0.25-1.5 microgram
daily orally), with or without calcium
supplements
 Type II – sometimes responds partially to
very high doses of active vitamin D
metabolites & calcium and phosphate
supplements.

18. Treatment
18
 Renal rickets and osteomalacia
They occur in patients with chronic renal failure
due to:
Defects in synthesis of 1,25(OH)2D3
Over treatment with oral phosphate binders
Treatment
1-alpha hydroxylated vitamin D
Dietary restriction of foods with high
phosphate content (milk, cheese, eggs)
Phosphate-binding drugs (calcium
carbonate, aluminum hydroxide)
Pathogenesis, diagnosis and management of osteomalacia
Jennie Walker. doi: 10.7748/nop.26.6.32.e593

19. Treatment
19
Hypophosphatemic rickets and osteomalacia
Causes
 Inherited or acquired defects in renal tubular
phosphate reabsorption
 Tumours that secrete phosphaturic substance
Clinical features & diagnosis
 Hereditary disorders present as rickets. The diagnosis
is made on the basis of the presence of
hypophosphatemia with renal phosphate wasting in
the absence of vitamin D deficiency.
 Tumour-induced disorder presents with severe ,
rapidly progressive symptoms in patients with no
obvious predisposing factor for osteomalacia.
Pathogenesis, diagnosis and management of osteomalacia
Jennie Walker. doi: 10.7748/nop.26.6.32.e593

20. Phosphate supplements (1-4g daily) +
active metabolites of vitamin D (to
promote intestinal calcium and phosphate
absorption)
Tumour-induced osteomalacia is treated
in the same way + surgical excision of the
tumour
20
Treatment
Pathogenesis, diagnosis and management of osteomalacia
Jennie Walker. doi: 10.7748/nop.26.6.32.e593

21. 21