7. Defective bone mineralization:
Osteoporosis
● Quantity: low
● Quality: good
Osteomalacia
● Quantity: good
● Quality: low
Osteomalacia: softening of bone due to
defective bone mineralization in adults.
Rickets: softening of bone due to defective
bone mineralization in infants (children).
10. Osteomalacia means “soft bones”
Osteomalacia is metabolic bone disorder ,
deziretcarahc
yb
,etauqedani
deyaled
ro
evitcefed mineralization fo
enob
xirtam
ni
erutam
tcapmoc
ro
ygnops
enob
.
In children ,
ti
si
nwonk
sa rickets .
Osteomalacia is a disease that weakens bones and can cause them to break
more easily. The bone tends to break down faster than it can re-reform. As a
result of calcium deficiency, muscle weakness, and unsteadiness, there is an
increased risk for falls and fractures
11. PATHOPHYSIOLOGY
The softer bones in osteomalacia have a normal amount of collagen, which
gives the bones its structure. They lack proper amount of calcium and usually
caused by low levels of vitamin D
12.
13.
14. Signs and Symptoms of Osteomalacia )SNOITATSEFINAM LACINILC(
There are usually no apparent signs and symptoms in the early stages of osteomalacia. As it
progresses, the following manifestations will start to become noticeable:
● Bone and joint pain nac teef eht no niap ;seenk dna ,shgiht reppu ,sgel ,niorg eht ni yllausu
gniklaw dna gnidnats nehw deton eb osla
.
● Muscle pain – commonly affects movements and may make getting out of bed a struggle
(specially proximal muscles eg. (thigh, lumber muscles) then, pain diffused to distal muscles).
● Weakness after exercising
● Looser’s zones – weight-bearing bones start to break easily (hips, lower back, feet). Breaks
related to osteomalacia are referred to as Looser’s zone. They are usually impartial breaks
which can lead to complete fractures.
● Waddling gait serutcarf laitrap dna ,niap ,ssenkaew elcsum ot eud deton eb yam
.
● Muscle cramps
● Pins and needles sensationslevel muiclac wol yb desuac teef dna sdnah eht ni
15. Cont.
● Bowing of bones –dorsal kyphosis
● Progressive deformities of bones of extremities and spine
● Rachitic rosary: osteo-deposition in costal chondrajunction
● Difficulty in changing position lying to sitting position and sitting to
standing position. + (squatting position)
● Enlarged wrists and ankles
● Pigeon breast deformities. (protruding ribs and sternum)
● Difficulty walking and climbing stairs
● Kyphoscoliosis
● Frontal bossing: osteo-deposition in skull.
16. Symptoms may also due to low calcium levels
● Numbness around the mouth
● Numbness of the arms and legs
● Spasms of the hands or feet
17. Causes of Osteomalacia
Like most cells in the human body, bones are made up of cells that require
nutrients for their survival. Calcium and phosphorus are needed to make the
outer shell of the bones strong. Vitamin D makes this happen as it is
responsible for the absorption of these minerals to the bones. Any disruption
on this process can cause osteomalacia.
1. Low levels of Vitamin D muiclac fo noitprosba eht ni pleh D nimatiV .
rooP .senob eht nehtgnerts ot desu eb nac yeht os surohpsohp dna
htob nac erusopxe nus etauqedani dna D nimatiV fo ekatni yrateid
esuac
Vitamin D deficiency
18. Causes of vit. D. deficiency
A. Reduce cutaneous synthesis
B. Pt. with burn injuries
C. Nutritional deficiency
D. GI disease (malabsorption associated with disease of the small intestine, extra Hepatic bi-liary
obstruction, diseases of bancreas, result in low absorption of vit. D. chronic diarrhea, pregnancy)
E. Liver disease
F. Drugs: an precipitate vit. D. by enhancing catabolism of vit. D. :
Antiretroviral drugs, eg. Zidovodine
Anticonvulsants eg. Phenytoin, pheno-barbitone & carbamazepine
Others, eg. Isoniazid, rifampicin & theophylline.
G. Chronic renal diseases (CRD)
H. Elderly people:
Cataneous vit. D. production & vit. D. stores decline with age
Low iintake of vit. D. in older subjects
Achlorohydria, common in elderly, low Ca absorption
I. Obesity: vit. D. is sequestrated in fat.
19. Cont.
2. Surgeries. Most of the nutrient absorption happens in the stomach and the intestines.
Surgeries that involve removal of parts of these organs can cause inadequate
absorption of minerals including calcium.
3. Celiac Disease. Celiac disease is a condition where the body reacts to gluten when
ingested. The reaction causes the destruction of the intestinal lining called villi, which
are finger-like structures responsible for the absorption of nutrients.
4. Kidney or liver diseases. Vitamin D is activated by the liver and kidneys when needed.
Any conditions that affect the functions of the liver and kidneys can cause inactivation of
Vitamin D, therefore causing osteomalacia.
5. Medications. Certain medications can cause Vitamin D deficiency, such as anti-seizure
drugs, including phenytoin and Phenobarbital, and Prolonged use of antacids.
(Systematic acidosis in renal tubular acidosis).
20.
21.
22. Complications of Osteomalacia
The following are the known complications of osteomalacia:
● Further broken bones pu dne yam senob eht ni skaerb etelpmocnI .
serutcarf etelpmoc gnimoceb
.
● Stunted growth ydob eht rof elbisnopser osla era senoB .
’ s stature.
Inadequate nutrients cause underdeveloped bone structure.
● Hypocalcemic seizures lanoruen eht retla nac slevel muiclac etauqedanI .
niarb eht fo seitivitca
.
● Kidney failure. dna pu pmulc yeht ,senob eht otni debrosba ton si muiclac fI
muiclac ssecxe eht etercxe ot yrt neht syendik ehT .maerts doolb eht ni yats
senots yendik esuac nac siht ,revewoH .slevel
.
● Physical disability stnemevom dna ytilibom ni elor lativ a yalp senoB .
.
23. Diagnosis of Osteomalacia )noitaulave citsongaid(
The diagnosis of osteomalacia usually occurs in the later stage of the disease as it doesn’t usually
present any signs and symptoms in the early stages.
Aside from history taking and physical exam, the following diagnostic tests may be performed:
● Blood tests – a simple blood test to check for the levels of calcium, phosphorus, and vitamin D
in the blood. It may also include the levels of alkaline phosphatase and parathyroid hormone
to support the diagnosis. Alkaline phosphatase (ALP( enomroh dioryhtarap dna )PTH eb lliw )
aicalamoetso htiw nosrep a ni desiar
.
● Urine test eninitaerc dna muiclac tceted ot
.
● Imaging – X-ray images will show the breaks and fractures consistent with osteomalacia .
● Bone density test gninetfos enob dna ,ssol enob ,erutcarfoduesp tceted pleh nac
.
● Bone biopsy – will show bone softening, to give a clinician an accurate diagnosis of
osteomalacia, however, it is not usually necessary as blood tests are often helpful and
definitive.
24. MEDICAL MANAGEMENT
The treatment of osteomalacia relies on addressing the cause of the bone weakness and softening.
● Generally, people with osteomalacia take vitamin D, calcium and phosphorus supplements by
mouth for a period of several weeks to several months. (Safe use of vitamin D supplements
recommended as higher doses are toxic as it increases the level of calcium).
● People who cannot properly absorb nutrients through the intestines may need larger doses of
vitamin D and calcium.
● Calcitriol (in renal disease)
● Exposures to sunlight also prescribed to patient
● Provide a diet with adequate protein and increased calcium and vitamin D (e.g., fortified milk
and cereals, eggs, chicken livers)
● Treating any condition affecting vitamin D metabolism, such as kidney disease or low
phosphate levels, often helps improve the signs and symptoms of osteomalacia
● Pain killers. When the vitamin D supplement is started, the breaks in the bones usually heals
on their own. However, pain can persist while healing is taking place.
25. NURSING MANAGEMENT
● Advice the patient about intake of diet rich in calcium and phosphorus
● Teach about safety measures to prevent falls i.e. proper light in bathroom,
hallways and avoid slippery floors and use of grab rails in bathrooms for
shower and bath tubs and toilet seats
● Reduce the patient’s discomfort and pain. Assist the patient to change
positions, handles the patient gently, and pillows are used to support the body
● Encourage the patient towards use of assistive devices –walkers sticks, canes
or crutches while ambulating
● Teach the patient to observe anorexia, nausea/vomiting, frequent urination,
muscle weakness and constipation as these are the systems of vitamin D
toxicity. It exists, concern the physician.
26. Cont.
● Instruct the patient to focus on careful positioning, ambulation, and
prescribed exercises.
● Teach client how to use ambulatory device with physical therapist’s
assistance as necessary
● Teach client about high fracture risk even with minor trauma related to
fragile bone status
28. Nursing Care Plan for Osteomalacia 1
Nursing Diagnosis: niaP etucA related to fo ssecorp esaesid eht
aicalamoetsoas evidenced by fo erocs niap
10 out of 10
fo noitazilabrev ,
,gniyrc ,ecamirg laicaf ,aera detceffa eht no ngis gnidraug ,niap enob prahs
ssensseltser dna
Desired Outcome: decnedive sa niap fo feiler etartsnomed lliw tneitap ehT
fo erocs niap a yb
0 out of 10
ssensseltser fo ecnesba dna ,sngis lativ elbats ,
.
30. Nursing Care Plan for Osteomalacia 2
Nursing Diagnosis: stnemeriuqeR ydoB naht sseL noitirtuN decnalabmI
related to aicalamoetso ot yradnoces D nimativ etauqedani as evidenced by
elcsum dna ,niap tnioj dna enob ,spmarc elcsum ,slevel D nimativ mures wol
ssenkaew
.
Desired Outcome: slevel D nimativ mures lamron hsilbatse lliw tneitaP
.
32. Nursing Care Plan for Osteomalacia 3
Nursing Diagnosis: Activity intolerance related to niap enob dna tnioj
,aicalamoetso ot yradnocesas evidenced by fo erocs niap
10 out of 10
,
dna ssenderit fo noitazilabrev ,niap ot eud sLDA ni tseretnisid ,eugitaf
ssenkaew dezilareneg
Desired Outcome: ni noitapicitrap evitca noitartsnomed lliw tneitap ehT
slevel ytivitca ni esaercni etartsnomed dna seitivitca derised dna yrassecen
.
