A Family Doctor's Tale - OSTEOMALACIA

DOC I HAVE OSTEOMALACIA

Osteomalacia is a metabolic bone condition in adults characterized by the lack of nineralization of the bone or osteoid matrix although the osteoid is otherwise normal and the osteoid bone is unaltered.

Causes:
Osteomalacia occurs
1.when there is vitamin D deficiencies due to
a.diet
b.malabsorption

2.Vitamin D deficiecy is common in the elderly especially people who have dark skin and are not exposed to the sun

3.Malabsorption of Vitamin D may occur in gluten enreropathy or post gastectomy

4.Renal disease and anticonvulsant drugs may reduce the formation of active metabolites of vitamin D

5.Certain medications can cause Osteomalacia. These include long-term use of heparin (a blood thinner), anti-seizure medications phenytoin (Dilantin) and phenobarbital, and long term use of oral corticosteroids (such as Prednisone).

6.Rarely calcium deficiecy is a cause of osteomalacia

Symptoms:
1.Osteomalacia is a silent disease.
People with Osteomalacia often do not know that they have the condition.

2.Fractures from Osteomalacia commonly occur in the wrist, spine and hip.
Persons with fractures may complain of pain and deformities as a result of the fractures.

3.Muscle weakness may occur when serum calcium is very low

Diagnosis:
1.Blood calcium and organic phiosphates are low or low normal

2.Blood alkaline phosphatase is increased

3.Blood Vitamin D levels are low

4.X-rays showed typical fractures (Looser zones) in pelvis, long bones, metacarpals and metatarsals

Treatment:
The goal of Osteomalacia treatment is the prevention of bone fractures by stopping bone loss and by increasing bone density and strength.

Therefore, prevention of Osteomalacia is as important as treatment. Osteomalacia treatment and prevention measures are:

A.Lifestyle Changes:
Exercise has a wide variety of beneficial health effects. However, exercise does not bring about substantial increases in bone density.

B.Medications:
1.Vitamin D
An adequate calcium intake and adequate body stores of vitamin D are important foundations for maintaining bone density and strength.
Vitamin D is important in several respects:

Vitamin D helps the absorption of calcium from the intestines.
A lack of vitamin D causes calcium-depleted bone (osteomalacia), which further weakens the bones and increases the risk of fractures.
Vitamin D, along with adequate calcium (1200 mg of elemental calcium), has been shown in some studies to increase bone density and decrease fractures in older postmenopausal, but not in premenopausal or perimenopausal women.
Vitamin D comes from the diet and the skin.
Vitamin D production by the skin is dependent on exposure to sunlight. Active people living in sunny regions can produce most of the vitamin D they need from their skin.

2.Calcium Supplements
Building strong and healthy bones requires an adequate dietary intake of calcium and exercise beginning in childhood and adolescence for both sexes.
Calcium supplements are safe and generally well tolerated. Side effects are indigestion and constipation.

3.Medications that stop bone loss and increase bone strength, such as
alendronate (Fosamax),
risedronate (Actonel),
raloxifene (Evista),
ibandronate (Boniva),
calcitonin (Calcimar);

Prognosis:
1.good response to treatment in vitamin D deficiciency.

2.treat underlying cause such as malabsorption to get a good response in the treatment of osteomalacia.