Osteomalacia: Difference between revisions

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Revision as of 17:15, 12 December 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]


Overview

Osteomalacia
ICD-10 M83
ICD-9 268.2
DiseasesDB 9351
eMedicine ped/2014  radio/610
MeSH D010018

WikiDoc Resources for Osteomalacia

Articles

Most recent articles on Osteomalacia

Most cited articles on Osteomalacia

Review articles on Osteomalacia

Articles on Osteomalacia in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Osteomalacia

Images of Osteomalacia

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Podcasts & MP3s on Osteomalacia

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Evidence Based Medicine

Cochrane Collaboration on Osteomalacia

Bandolier on Osteomalacia

TRIP on Osteomalacia

Clinical Trials

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Trial results on Osteomalacia

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Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Osteomalacia

NICE Guidance on Osteomalacia

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CDC on Osteomalacia

Books

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News

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Commentary

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Definitions

Definitions of Osteomalacia

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Risk calculators and risk factors for Osteomalacia

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Symptoms of Osteomalacia

Causes & Risk Factors for Osteomalacia

Diagnostic studies for Osteomalacia

Treatment of Osteomalacia

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International

Osteomalacia en Espanol

Osteomalacia en Francais

Business

Osteomalacia in the Marketplace

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Experimental / Informatics

List of terms related to Osteomalacia

Osteomalacia is the defective uptake of minerals into the normal or overgrowing protein bone matrix. It is considered a secondary bone formation impairment. It can lead to increased bone softness and a curvature of the bone. Osteomalacia in children is known as rickets, and because of this, 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. A common cause of the disease is a deficiency in Vitamin D, which is normally obtained from the diet and/or sunlight exposure.

General characteristics

Osteomalacia in the adult is most commonly found in confined, dark-skinned, or diet-disbalanced subjects. Many of the effects of the disease overlap with the more common osteoporosis, but the two diseases are significantly different. Osteomalacia is specifically a defect in mineralization of the protein framework known as osteoid. This defective mineralization is mainly caused by lack in vitamin D.

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


Common Causes

Causes by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Phenytoin, Glutethimide, Fluoride, Etidronate, Ethotoin, Bisphosphonates, Anticonvulsants, Antacids, Aluminium, Isotretinoin, Tenofovir
Ear Nose Throat No underlying causes
Endocrine Hypoparathyroidism
Environmental Inadequate sunlight exposure
Gastroenterologic Small bowel disease, Pancreatic insufficiency, Malabsorption syndrome, Gastrectomy, Gastrointestinal bypass, Biliary cirrhosis, Alcoholic cirrhosis
Genetic Autosomal dominant hypophosphatemic rickets
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal/Orthopedic Osteogenesis imperfecta, Fibrogenesis imperfecta, Axial osteomalacia
Neurologic No underlying causes
Nutritional/Metabolic Wilson disease, Vitamin D dependent rickets type 2a, Vitamin D dependent rickets type 1, Vitamin D deficiency, Malnutrition during pregnancy, Disorders of vitamin D metabolism, Cystinosis
Obstetric/Gynecologic No underlying causes
Oncologic Multiple myeloma
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte Proximal renal tubular acidosis, Nephrotic syndrome, Hypophosphataemia, Hypokalaemic distal renal tubular acidosis, Chronic renal failure
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous Oncogenic osteomalacia, Dent disease, Sporadic acquired hypophosphatemic rickets

Causes in Alphabetical Order


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. Pain is non-radiating, symmetrical, and accompanied by tenderness in the involved bones. Proximal muscles are weak, and there is difficulty in climbing up stairs and getting up from a squatting position. Physical signs include deformities like triradiate pelvis and lordosis. The patient has a typical "waddling gait". Pathologic fractures due to weight bearing may develop. Most of the time, the only alleged symptom is chronic fatigue and bone aches are not spontaneous but only revealed by pressure or shocks.

Biochemical findings

Biochemical features are similar to rickets.The major fact is a collapsed vitamine D rate in blood or serum.

Radiographic characteristics

X Ray

Radiological appearances include

  • Indistinct border to the medullary spongiosa
  • Thinning of the basal lamina and end plates
  • Loss of definition in the trabecular details
  • Separation of the compact bone layers
  • Pseudofractures
  • Protrusio acetabuli

Differential Diagnosis of Causes of Osteomalacia

Lack of Circulating Vitamin D

Peripheral Resistance to Vitamin D

Hypophosphatemia

Miscellaneous

Treatment

Nutritional osteomalacia responds well to administration of 200000 IU weekly of vitamin D for 4 to 6 weeks, followed by a maintenance dose of 1600 IU daily or 200000 IU every 4 to 6 months.

Related Chapters


Template:Nutritional pathology Template:Diseases of the musculoskeletal system and connective tissue

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