Osteomalacia only

2. X-ray
of a 60 years
old female.
Proceed…!

3. Osteomalacia
Dr. Bilal ahmad
PG Trainee
MTI LRH

4. Objectives
By the end of my 30 minutes presentation the participants
will be able to;
 Describe the basic pathophysiology of bone metabolism
 Enlist the steps of diagnosis of osteomalacia
 Describe the treatment plan of osteomalacia
 Elaborate preventive strategies

5. Contents
 Introduction
 Epidemiology
 Pathophysiology
 Causes
 Presentation
 Diagnosis
 Differentials
 Management
 Summary
 References

6. Introduction
Definition
Metabolic disease characterized by inadequate and
delayed mineralization of osteoid in mature compact
and spongy bone.

7. Bone composition
 The Matrix
 Organic components (40% )
 Mostly collagen
 Inorganic components (60%)
 calcium
 phosphate
 The cells
 Osteoblasts /osteocytes / osteoclasts

8. Bone mineralization
 Bone Mineral Hydroxyapatite
[Ca10(PO4)6(OH)2]
Vitamin D(Metabolism)

9.  Vitamin D(Functions)
*Intestinal Calcium
absorption
*Re-absorption of
Calcium from Kidneys
*Interaction with PTH
in regulation of blood
Calcium
*Mineralization of Bone

10. Epidemiology

11. Pathophysiology
Inadequately mineralized bone
The hardness and rigidity of bone is
due to the presence of mineral salt in
the osteoid matrix, which is a
crystalline complex of calcium and
phosphate (hydroxyapatite).
So deficiency of this hydroxyapatite
leads to osteomalcia.

12. Causes
 Deficiency of vitamin D
 Dietry
 Sun exposure

13.  Gastrointestinal Causes
 Gastric
 Intestinal
 Billiary
 Renal Causes
 Chronic Renal Failure
 Renal Tubular Acidosis
 Long term Renal Dialysis
 Fanconi Syndrome(Poisoning)

14.  Tumor Induced Osteomalacia
 FGF23
 Drugs
 Phenytoin
 Phenobarbital
 Carbamazepine
 Acetazolamide
 Aluminium Compound
 Flouride

15. Presentation
 >50yrs age
 Bone Pain
 Muscle Weakness
 Kyphosis/scoliosis
 Waddling gait
 Easy Fractures

16. Examination
 Muscle weakness
 Bone tenderness
 Tetany
 Widening of wrists
 Skeletal deformities

17. Lab investigations
 CBC
Electrolytes
Levels Of Calcium
Phosphorus
Calcium Phosphorus Index
Vitamin D
ALP
PTH

18. Findings ..
 Low serum Vit. D
 Low serum and urine Ca levels
 Elevated Serum and urinary Alkaline Phosphatase
 Low serum phosphate except in case of Renal
Osteodystrophy
 Elevated PTH due to low calcium

20. Radiological findings
 Fractures.
 Pseudofractures, also called Looser’s Zones.
 Codfish vertebrae.
 Protrusio Acetabuli, a hip joint disorder.

21. Fracture

22. Looser’s zone

23. Codfish vertebrae..

24. Protrusio acetabuli..

25. Differentials
I. Hypophosphatasia
II. Jansen Syndrome
III. Severe Calcium deficiency
IV. Severe Phosphorus deficiency

26. Complications
 Respiratory: Infections or atelectasis due to chest
deformities.
 GIT: Constipation
 Bony deformities: Or fractures
 Anemia: Due to chronic infection or deficiencies.

27. Management
Primary prevention
 Adequate sun exposure
 Diet rich in calcium
 Treatment of underlining conditions/dieseases

28. Continue…
 Pharmacological treatment
 Nutritional osteomalacia responds well to
administration of 10,000 IU weekly of Vit. D for 4-6
weeks.
 Osteomalacia due to malabsorption may require
treatment by injection or oral dosing of significant
amounts of Vitamin D.
 Calcium and phosphorus supplements.

29. Elderly
• Dec exposure to sunlight
• Less dietry calcium
Defective
mineraliza
tion
• Thinning of bones
Presenta
tion
• Bone pains, muscle weakness
Manage
ment
• Supplements and sun exposure

30. Question ..
 Which statement is true regarding Vit-D function
 Increase GI Calcium and phosphate absorp
 Only phophate absorption
 Only calcium absorption

31. Question..
 How much Asian adults are Vit-D deficient
 1 in 5
 1 in 8
 1 in 3

32. Question ..
 Which of the following drug/s can cause Vit-D def
 (a) Carbamazepine
 (b) Phenytion
 Only option a
 Both a and b

33. Question ..
 Most common cause of osteomalacia is
 Vit-D deficiency
 Calcium deficiency
 Phosphate deficiency

34. Question ..
 Most common presentation of osteomalacia is
 Carpopedal spasm (tetany)
 Bone pain and tenderness
 Muscle weakness

35. Question ..
 Serum phosphate level is low in all causes of
Osteomalacia except
 Tumor induced osteomalacia
 Renal osteodystrophy
 Fanconi syndrome

36. References
 http://painreliveonlypt.blogspot.com/2014/10/osteomalacia-causes-risk-
factors.html
 http://www.arthritisresearchuk.org/arthritis-
information/conditions/osteomalacia/what-is-osteomalacia.aspx
 http://www.vitaminsestore.com/osteomalacia-causes-treatments-symptoms-
and-risk-factors/
 http://slideplayer.com/slide/2428214/

37. Acknowledgement
 Dr. Farooq ahmed

38. Thank you