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Osteomalacia

Overview

Osteomalacia is a disorder affecting adults in which a person has soft bones due to impaired bone metabolism caused by inadequate levels of minerals in the blood. These minerals include mainly calcium, phosphate, magnesium, etc. the most common reason behind the disorder is the deficiency of Vitamin D, which is required for the absorption of calcium from the gut. Vitamin D is derived from the conversion of cholesterol to cholecalciferol in the body via exposure to sunlight. Symptoms of osteomalacia include pain in the body, muscular or bone pain, muscle weakness, and fracture of the bones. It is diagnosed by measuring the levels of minerals in the blood and is treated by supplying those deficiencies, especially vitamin D. 

Causes

Our bones are made strong through a process of bone mineralization which refers to the incorporation of ionized calcium and other minerals in the osteoid tissue in the bones. This process is dependent on the constant adequate supply of these minerals. When this process is interrupted, it results in soft bones or osteomalacia. The deficiency of minerals can be due to the dietary deficiency or resistance to the action of vitamin D, gut conditions interfering with the absorption, or renal diseases resulting in the loss of the minerals in the urine. The conditions that lead to the deficiency of these minerals include;

·         Dietary deficiency of vitamin D, calcium, phosphate

·         Renal tubular acidosis

·         Malnutrition

·         Malabsorption syndromes

·         Chronic kidney failure

·         Tumor-induced osteomalacia

·         Celiac disease

·         Eating disorders

·         Crohn’s disease/ ulcerative colitis

·         Parathyroid hormone disorders

Risk Factors And Epidemiology

Osteomalacia affects 1 in 1000 people worldwide. The following factors can increase your chances of suffering from osteomalacia.

·         Residing  in regions with minimum sun exposure

·         Not going out in the sun

·         Suffering from gut diseases related to absorption

·         Having a severe renal disease

·         If you or your loved ones are living in the nursing homes

·         Homebound elderly population 

Signs And Symptoms

You may not have prominent symptoms at the beginning of the disease. Later, you may develop the following symptoms;

·         Generalized weakness and fatigue

·         Diffuse pain in the joints and bones, especially in the spine, pelvis, and legs

·         Weakness in the muscles

·         Difficulty in walking, probably with a waddling gait

·         Signs of Hypocalcemia, for example, positive Chvostek sign

·         Shortening of the height due to Compression of vertebrae

·         Flattening of the pelvis

·         Soft and weakened bones often susceptible to fractures

Diagnosis

If you feel you might be suffering from osteomalacia, you should talk to your healthcare provider. They will elicit a detailed history and perform a physical examination to determine the cause. You may be advised to undergo the following investigations to confirm the diagnosis;

Blood tests: You may be asked to submit a sample of your blood to the laboratory to evaluate the levels of calcium, phosphate, and vitamin D, which all will be low. Alkaline phosphatase, an enzyme related to the activity of bone cells (osteoblast), may be increased. Parathyroid hormone levels may also be checked.

Urine test: Levels of the minerals may also be checked in your urine to find out over-excretion.

Imaging: X-rays of the particular regions may show fractures and signs of osteomalacia.

Bone density scan: This scan can evaluate the amount of calcium and other minerals in the bones. They are not usually performed but can be helpful if the diagnosis is not clear.

Treatment

The treatment goals are to restore the deficiency of minerals and treat the underlying cause that may be related to the nutrition, gut, kidneys, etc.  If dietary deficiency is present, improve the diet and add vitamin D supplements (cholecalciferol) and calcium. If malabsorption is the problem, Vitamin D can be provided via injections.

Supportive therapies include;

·         Wearing braces or splints to support the bones

·         Surgical procedures to correct bone deformities or fractures

·         Ensure adequate sunlight exposure

Prognosis

Timely diagnosis and commencement of treatment can improve the symptoms considerably. In case of deformities, little can be done to restore the previous structure. For the other co-morbid conditions, adequate support should be provided, and preventive measures should be taken to prevent these complications. 

Prevention

The following lifestyle changes can be made to prevent the development of osteomalacia;

·         Include vitamin D and calcium-rich food in the diet

·         Try to get adequate exposure to the sunlight

·         If you are suffering from the diseases mentioned above, take special care and talk to your doctor about your concern regarding osteomalacia.

·         If you feel you are not getting enough sunlight exposure, add Vitamin D supplements to the diet after consulting with your doctor.

·         Perform regular exercise to strengthen your bones and improve muscular activity.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 05, 2023.

Reference

https://www.ncbi.nlm.nih.gov/books/NBK551616/#:~:text=Osteomalacia%20describes%20a%20disorder%20of%20%E2%80%9Cbone%20softening%E2%80%9D%20in%20adults%20that,of%20growth%20plates%20in%20children.

https://www.sciencedirect.com/science/article/abs/pii/S0950351X97805691

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