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Osteomalacia

Definition and Epidemiology

  • Osteomalacia refers to the softening of bones due to defective bone mineralization.
  • Predominantly caused by a deficiency of Vitamin D, calcium, or phosphate.
  • More common in regions with limited sunlight exposure and in populations with dietary deficiencies.

Pathophysiology

  • Inadequate mineralization of osteoid at the bone matrix due to deficiencies in Vitamin D, calcium, or phosphate.
  • Vitamin D deficiency is a primary cause, leading to decreased calcium absorption from the gut.
  • Can also result from malabsorption syndromes, chronic kidney disease, and certain medications.

Clinical Features

  • Gradual onset of bone pain and muscle weakness, often insidious and generalized.
  • Proximal muscle weakness and difficulty walking.
  • Bone tenderness, particularly in the pelvis and lower spine.
  • Increased risk of fractures, especially in weight-bearing bones.

Diagnosis

  • Based on clinical presentation, biochemical markers, and radiological findings.
  • Blood tests: Low levels of calcium and phosphate, high alkaline phosphatase, low or normal parathyroid hormone.
  • X-rays may show Looser’s zones (pseudofractures).
  • Bone biopsy is definitive but rarely required.

Management

  • Correction of underlying Vitamin D, calcium, or phosphate deficiencies.
  • Oral Vitamin D and calcium supplementation.
  • Addressing risk factors: improving dietary intake, safe sun exposure, managing chronic diseases.
  • In cases due to renal failure, treatment of the underlying renal condition is crucial.

Complications

  • Chronic pain and deformities.
  • Increased susceptibility to fractures.
  • Potential progression to osteoporosis if left untreated.

Prognosis

  • Good with early diagnosis and appropriate treatment.
  • Reversal of symptoms and bone strengthening is possible with adequate management.

Prevention

  • Adequate intake of Vitamin D and calcium.
  • Regular, safe sun exposure for Vitamin D synthesis.
  • Early detection and management of conditions that can lead to osteomalacia.

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