Osteomalacia/Rickets

Glenda Vazquez
 Introduction
 Osteomalacia is known as the softening
of bones due to insufficient vitamin D,
or problems with the break down of this
vitamin. This disease is also known as
rickets in children.Bones with
osteomalacia have sufficient amounts
of collagen which gives the bones their
structure, but they lack calcium. The
softness of the bones is more likely to
cause bow and fractures.
 Causes/Rick Factors
 The most common cause of osteomalacia is a deficiency of vitamin
D. Vitamin D insufficiency can cause osteomalacia because vitamin D
facilitates calcium absorption and other minerals in the gastrointestinal tract
necessary for bone building. Lack of vitamin D, calcium and other minerals
aren’t absorbed efficiently, so they are not available for mineralization in the
bone building process. This then result in soft bones.
• Insufficient sunlight exposure Sunlight makes vitamin D in your skin.
Therefore osteomalacia can develop in people who spend little time in the
sunlight, wear very strong sunscreen, live in areas where sunlight hours are
short, or where the air is smoggy.
• Insufficient vitamin D intake A diet low in vitamin D is the most common
cause seen worldwide. Is less common in the U.S. because many foods,
such as milk and cereals are fortified with vitamin D.
• Certain Surgeries The removal of part or all of your stomach known as
gastrectomy, can lead to this disease because the stomach breaks down
foods to release vitamin D and other materials, which are then absorbed by
your intestines. Surgery removing or bypassing your small intestine can
lead to osteomalacia.
• Chronic pancreatitis Pancreatitis is the long-standing inflammation of your
pancreas, an organ that makes digestive enzymes and hormones. If the
pancreas is inflamed enzymes in charge of breaking down food and
releasing nutrients do not flow as freely into your intestines.
• Chronic sprue In this autoimmune disorder, the lining of the small intestine
is damaged by consuming foods having gluten, a protein found in wheat,
barley, and rye. Damaged intestinal lining doesn’t absorb nutrients, such as
vitamin D, as well as a healthy one would.
 Incidence/Prevalence
• In the United States it is estimated that 20 to 25 million people
suffer from osteomalacia, including 25 percent of women beyond
menopause
• Incidence of 1 per 1000 people in the United States
• Rickets: In the U.S., severe nutritional rickets has become rare,
although the mild disorder continues in the high-risk population
(eg, individuals with dark skin, persons who live in inner-city
areas). Breastfed infants who receive no vitamin D
supplementation also are at risk.
 Rickets: Incidence in Europe is similar to that in the U.S. In
sunny areas, such as in the Middle East, rickets may occur when
infants are bundled in clothing and are not exposed to sunlight.
In some parts of Africa, deficiency of calcium and/or
phosphorous in the diet may lead to rickets.
  Symptoms/Diagnosis
 In the early stages of osteomalacia a person may not feel the symptoms, but may be
seen in x-rays or diagnostic tests. As osteomalacia worsens symptoms may include
bone pain and muscle weakness. Bone pain is especially felt in the lower spine, pelvis,
legs and feet. The pain is dull and aching and get worse with physical activity. Even
gentle pressure on the bone may cause severe pain.
 Osteomalacia may cause weakness and stiffness in the arms and legs, decreased
muscle tone and discomfort during movement. Some people also walk with a waddling
motion.
 When diagnosing osteomalacia, doctors will inquire about the patient’s time spent in the
sun and about their diet. In order to rule out other bone diseases the following tests may
be conducted:
 Blood and urine tests In the cases caused by vitamin D deficiency or phosphorous
loss, abnormal levels of vitamin D and minerals calcium and phosphorous are often
detected through blood and urine tests.
 X-ray Slight cracks in the bones which are visible on x-rays known as looser
transformation zones are characteristic of people with osteomalacia ·      Bone scan
Bone scans detect areas of high and low bone metabolism in your body. Radioactive
dye is injected in the vein and a picture of the amount of radioactive dye gathers in your
bones. Those with osteomalacia have radioactive dye unevenly distributed in some
areas of their bones.
 Bone biopsy A bone biopsy is performed by inserting a slender needle through the skin
and into the bone to withdraw a small sample, which is then viewed under a microscope.
Even though bone biopsies are very accurate in detecting osteomalacia, it is often not
needed to make the diagnosis.
 Treatment
Before After
 When osteomalacia is caused from a dietary or sunlight deficiency,
replenishing the low levels of vitamin D in the body usually cures the
condition. Doctors also recommend vitamin D supplements depending on
the dose needed and whether you have other health problems. Most
people with osteomalacia take vitamin D supplements by mouth for
several weeks or months. Although uncommon, vitamin D can also be
given as an injection or through a vein in the arm.
 If the blood levels of calcium and phosphorous are low the patient
may also take supplements of these minerals.
 After a patient begins treatment, they may undergo periodic blood
tests to assure blood levels of vitamin D and certain minerals are within
normal limits. X-rays are also taken to determine the improvement of the
bones. Symptoms may lessen within a few weeks of treatment. Doctors
suggest that patients continue taking vitamin D indefinitely to prevent the
return of osteomalacia.
 Prevention
 Osteomalacia caused by inadequate sun exposure and a diet low in vitamin D can be
prevented.
 Spend a few minutes in the sun Direct exposure in the sun to the arms and legs for
five to ten minutes daily is sufficient for adequate vitamin D production. If a person
lives in cold climate and don’t get enough sun exposure during the winter, they can
build enough vitamin D stores in the skin during warmer months. Although regular
use of sunscreen helps prevent skin cancer and premature aging of the skin, there is
concern that the frequent use of strong sunscreen can increase the risk of developing
ostemalacia.
 Eat food high in vitamin D Eat foods that are naturally rich in vitamin D such as oily
fishes (salmon, mackerel, and sardines) and egg yolks. Other foods that are fortified
with vitamin D include cereal, bread, milk, and yogurt.
 Take supplements If a person doesn’t get enough vitamins and minerals in their diet
or if they have a medical condition affecting the ability of their digestive system to
absorbing nutrients, they are recommended to ask a doctor about taking vitamin D
and calcium supplements.
 Exercise Exercise such as walking helps strengthen bones, but if a patient has slight
fractures due to osteomalacia, they should avoid strenuous activity until their bones
heal.
 Questions
1. Osteomalacia is known as the softening of bones due to
insufficient vitamin D, or problems with the break down of
this vitamin.
A) True B) False

2. The most common cause of osteomalacia is ____.

3. The softness of the bones is more likely to cause bow and

4. Osteomalacia can develop in people who a lot little time in the