Osteomalacia

Osteomalacia (rickets)
Classification and external resources
ICD-10	M83
ICD-9	268.2
DiseasesDB	9351
MedlinePlus	000376
eMedicine	ped/2014 radio/610
MeSH	D010018

Osteomalacia is the softening of the bones caused by defective bone mineralization secondary to inadequate amounts of available phosphorus and calcium, or because of overactive resorption of calcium from the bone as a result of hyperparathyroidism (which causes hypercalcemia, in contrast to other aetiologies). Osteomalacia in children is known as rickets, and because of this, use of the term osteomalacia is often restricted to the milder, adult form of the disease. It may show signs as diffuse body pains, muscle weakness, and fragility of the bones. The most common cause of the disease is a deficiency in vitamin D, which is normally obtained from the diet and/or from sunlight exposure.

General characteristics

Osteomalacia is a generalized bone condition in which there is inadequate mineralization of the bone. Many of the effects of the disease overlap with the more common osteoporosis, but the two diseases are significantly different. There are two main causes of osteomalacia: (1) insufficient calcium absorption from the intestine because of lack of dietary calcium or a deficiency of, or resistance to, the action of vitamin D; and (2) phosphate deficiency caused by increased renal losses.

Osteomalacia is derived from Greek: osteo- which means "bone", and malacia which means "softness". In the past, the disease was also known as malacosteon and its Latin-derived equivalent, mollities ossium.

Causes

The causes of adult osteomalacia are varied, but ultimately result in a vitamin D deficiency:

• Insufficient nutritional quantities or faulty metabolism of vitamin D or phosphorus
• Renal tubular acidosis
• Malnutrition during pregnancy
• Malabsorption syndrome
• Hypophosphatemia
• Chronic renal failure
• Tumor-induced osteomalacia
• Long-term anticonvulsant therapy
• Coeliac disease
• Cadmium poisoning, Itai-itai disease

Signs and Symptoms

• Weak bones
• Bone pain
  • Spinal bone pain
  • Pelvic bone pain
  • Leg bone pain
• Muscle weakness
• Hypocalcemia
• Compressed vertebrae
• Pelvic flattening
• Easy fracturing
• Bone softening
• Bending of bones

Clinical features

Osteomalacia in adults starts insidiously as aches and pains in the lumbar (lower back) region and thighs, spreading later to the arms and ribs. The pain is symmetrical, non-radiating and is accompanied by sensitivity in the involved bones. Proximal muscles are weak, and there is difficulty in climbing up stairs and getting up from a squatting position.

Due to demineralization bones become less rigid. Physical signs include deformities like triradiate pelvis and lordosis. The patient has a typical "waddling" gait. However, those physical signs may derive from a previous osteomalacial state, since bones do not regain their original shape after they become deformed.

Pathologic fractures due to weight bearing may develop. Most of the time, the only alleged symptom is chronic fatigue, while bone aches are not spontaneous but only revealed by pressure or shocks.

It differs from renal osteodystrophy, where the latter shows hyperphosphatemia.

Biochemical findings

Biochemical features are similar to those of rickets. The major factor is an abnormally low vitamin D concentration in blood serum.

Major typical biochemical findings are given below:

• The serum calcium is low
• Urinary calcium is low
• Serum phosphate is low except in cases of renal osteodystrophy
• Serum alkaline phosphatase is high

Furthermore, a technetium bone scan will show increased activity.

Comparison of bone pathology

Condition	Calcium	Phosphate	Alkaline phosphatase	Parathyroid hormone	Comments
Osteopenia	unaffected	unaffected	normal	unaffected	decreased bone mass
Osteopetrosis	unaffected	unaffected	elevated	unaffected	thick dense bones also known as marble bone
Osteomalacia and rickets	decreased	decreased	elevated	elevated	soft bones
Osteitis fibrosa cystica	elevated	decreased	elevated	elevated	brown tumors
Paget's disease of bone	unaffected	unaffected	variable (depending on stage of disease)	unaffected	abnormal bone architecture

Radiographic characteristics

Radiological appearances include:

• Pseudofractures, also called Looser's zones.
• Protrusio acetabuli, a hip joint disorder

Treatment

Nutritional osteomalacia responds well to administration of 10,000 IU weekly of vitamin D for four to six weeks. Osteomalacia due to malabsorption may require treatment by injection or daily oral dosing of significant amounts of vitamin D.

See also

• Osteopetrosis, the opposite of osteomalacia

Pediatric glossary of terms | Glossary of medical terms | Dictionary of pediatrics

Table of contents:

.A | .B | .C | .D | .E | .F | .G | .H | .I | .J | .K | .L | .M

.N | .O | .P | .Q | .R | .S | .T | .U | .V | .W | .X | .Y | .Z

# - A

• Adrenal gland disorders
• AIDS / HIV
• Amenorrhea
• ADHD or Attention deficit/hyperactivity disorder
• Autism spectrum disorder (ASD)

B

• Bacterial vaginosis
• Birth control (see contraception)
• Birth defects
• Breastfeeding and breast milk
• Brittle bone disease also called osteogenesis imperfecta
• Bullying

C

• Cerebral palsy
• Childbirth see labor and delivery
• Childhood cancers
• Children's bone health and calcium
• Congenital adrenal hyperplasia (cah)
• Contraception and birth control
• Cushing syndrome
• Cyberbullying see bullying

D

• Delayed puberty see puberty and precocious puberty)
• Dental health in children
• Diabetes
• Down syndrome
• Driving risk
• Dyslexia

Table of contents:

.A | .B | .C | .D | .E | .F | .G | .H | .I | .J | .K | .L | .M

.N | .O | .P | .Q | .R | .S | .T | .U | .V | .W | .X | .Y | .Z

E

• Ear infections in children
• Early labor and birth (see preterm labor and birth)
• Early learning
• Early puberty (see puberty and precocious puberty)
• Eczema and atopic dermatitis
• Endometriosis

F

• Fertility problems (see infertility and fertility)
• Fibroids (see uterine fibroids)
• Fragile x syndrome
• Fragile x-associated primary ovarian insufficiency (fxpoi)
• Fragile x-associated tremor and ataxia syndrome (fxtas)

G

• Gestational diabetes (see diabetes)

H

• Hellp syndrome (see preeclampsia and eclampsia)
• High-risk pregnancy
• HIV and AIDS]]
• Hypoparathyroidism

I

• Infant care and infant health
• Infant mortality
• Infertility and fertility
• Intellectual and developmental disabilities

J

• Juvenile arthritis
• Juvenile diabetes (see diabetes)

K

• Klinefelter syndrome

L

• Labor and delivery
• Learning disabilities

Table of contents:

.A | .B | .C | .D | .E | .F | .G | .H | .I | .J | .K | .L | .M

.N | .O | .P | .Q | .R | .S | .T | .U | .V | .W | .X | .Y | .Z

M

• Maternal mortality
• Mccune-albright syndrome (mas)
• Men's reproductive health
• Menkes disease
• Menopause
• Menstruation and menstrual problems
• Miscarriage (see pregnancy loss (before 20 weeks of pregnancy))
• Monosomy x (see turner syndrome)
• Muscular dystrophy

N

• Necrotizing enterocolitis
• Neural tube defects
• Neuroscience
• Newborn screening
• Niemann-pick disease

O

• Obesity and overweight
• Osteogenesis imperfecta

Table of contents:

.A | .B | .C | .D | .E | .F | .G | .H | .I | .J | .K | .L | .M

.N | .O | .P | .Q | .R | .S | .T | .U | .V | .W | .X | .Y | .Z

P

• Pediatric injury
• Pelvic floor disorders
• Pelvic pain
• Pharmacology
• Phenylketonuria
• Pheochromocytoma and paraganglioma
• Pituitary tumors
• Polycystic ovary syndrome
• Prader-willi syndrome
• Preconception care and prenatal care
• Preeclampsia and eclampsia
• Pregnancy
• Pregnancy loss (before 20 weeks of pregnancy)
• Preterm labor and birth
• Primary ovarian insufficiency
• Puberty and precocious puberty

R

• Reading and reading disorders
• Rehabilitation medicine
• Rehabilitative and assistive technology
• Rett syndrome
• Rh incompatibility

S

• Sexually transmitted diseases
• Shaken baby syndrome
• Skipped or no menstrual periods (see amenorrhea
• Sleep
• Spina bifida
• Spinal cord injury
• Spinal muscular atrophy
• Stillbirth
• Stroke
• Sudden infant death syndrome

T

• Toxemia (see preeclampsia and eclampsia)
• Traumatic brain injury
• Trisomy 21 (see down syndrome)
• Turner syndrome

U

• Urinary tract health
• Uterine fibroids

V

• Vaginitis
• Vasectomy
• Vulvodynia

Table of contents:

.A | .B | .C | .D | .E | .F | .G | .H | .I | .J | .K | .L | .M

.N | .O | .P | .Q | .R | .S | .T | .U | .V | .W | .X | .Y | .Z

W

• Women's health

X

• Xo syndrome (see turner syndrome)
• Xxy syndrome (see klinefelter syndrome (ks))

Z

• Zika Glossaries and dictionaries | Medicine portal | Health Topics | Health Encyclopedia | First Aid | Weight Loss | Drugs | Glossary of medicine | insurance | Glossary of health topics | Drug classes | Medicines | Dentistry portal | Medications portal | Pharmacology portal | Psychiatry portal | Rare diseases | List of health topics | USMLE

edit 

WikiMD - medicine navigation