Osteomalacia is a rare bone disorder caused by vitamin D deficiency, primarily affecting women, leading to bone softening, fractures, and symptoms like fatigue and pain. Paget's disease, an idiopathic skeletal disorder, causes excessive bone resorption and formation of disorganized, weak bone, presenting with bone pain, deformities, and potential complications like tumors. Management for both conditions focuses on dietary adjustments, vitamin and calcium supplementation, pain relief, and physical therapy.

1. Osteomalacia
Adult rickets

2. Word Meaning
• Greek origin
• Osteo – bone
• Malacia - softness

3. Definition
• Osteomalacia is defined as a Rare
bone disorder associated with
vitamin D deficiency, resulting in
decalcification and softening of
bone.

4. Incidence
• Women mostly affected (Muslims)
• Its endemic in Asia

5.  Lack of exposure to UV rays (needed for
Vit.D synthesis)
 Drugs – anticonvulsants (phenytoin)
 GI malabsorption
 Extensive burns
 Chronic diarrhoea
 Pregnancy – multiple pregnancy
 Kidney disease
Etiology

6.  Excessive loss of calcium (celiac disease, biliary
tract obstruction, chronic pancreatitis)
 After surgery of gastrointestinal system

7. Pathophysiology
• Vit.D insufficiency
• Vit.D required for the absorption of the
calcium from the intestine
• Insufficient vit.D intake can interfere with the
normal mineralization of bone activity or
insufficient calcification of bone
• Leads to bone softening and associated
symptoms

8. Clinical features
• Bone become bent and flattened as they
soften
• Pathologic fracture
• Fatigue, malaise, bone pain (with tenderness)
• Difficult to walk, rise from a chair, low back
pain, progressive muscle weakness, weight
loss , deformity of spine (kyphosis), fracture
with delayed healing

10. Diagnostic investigation
• X-ray – generalized demineralization with
trabecular bone loss
• Bone biopsy
• Serum calcium and phosphorus levels are
reduced
• Alkaline phosphates level is moderately
elevated

11. Management
• Diet – vit D, calcium and phosphorous rich
• Vit.D3 (cholecalciferol), vit.D2 (ergocalciferol)
• Calcium salts and phosphorous supplements
may also prescribed
• Eggs, low fat milk, fish
• Exposure to sunlight
• Weight bearing exercises
• Orthopedic deformities may be treated with
surgery (osteotomy).

12. Nursing management
Assessment
• Assess for bone pain in the low back and
extremities
• Assess for fracture
• Obtain information about co existing diseases
(malabsorption syndrome) and dietary habits
• Note skeletal deformities on physical
examination

13. • Relieving pain – change in positions and
analgesic
• Improving body image – trusting relationship,
encourage patient to discuss any changes in
body image and methods of coping
• Encourage to use existing strength
• Allow talk with the similar successful patients

14. Nsg diagnosis
• Acute pain r/d to bone tenderness and
possible fracture
• Disturbed body image related to bowing of
legs, waddling gait and spinal deformities
• Deficient knowledge about disease process
and treatment

15. Pagets disease (osteitis deformans)

16. • Def - idiopathic Skeletal bone disorder in
which there is excessive bone resorption
followed by replacement of altered bone
tissue
• The new bone is larger, disorganized and
structurally weaker
• Common sites – pelvis , long bones, spine,
ribs, sternum and cranium

17. Etiology
• Exact cause is unknown
• Followed by viral infection (measles virus,
respiratory syncytial virus )
• Genetic (15%-30%)
• Men to women ratio – 2:1
• Seen in below 40 years

18. Pathophysiology
• Due to unknown causes
• Increase BONE RESORPTION
• Altered BONE TURN OVER
• As a compensatory mechanism - increase
bone formation
• Newly formed bones are large, unorganized
and weak
• Structural changes in weight bearing limbs and
other manifestation

19. Signs and symptoms
• Free of symptoms in the early stages
• Bone pain – deep ache – progress to severe
pain
• Fatigue
• Progressive development of waddling gait
• Become shorter
• Barrel chest

20. • Bowing of tibia or femur
• Changes in skin temperature
• Manifestations related to
nerve compression

21. • Increase bone volume in the spine can cause
spinal cord or cranial root compression leads
to head ache, blindness, vertigo, hearing loss
with tinnitus and dementia
• Pathologic fracture , osteosarcoma,
fibrosacroma and osteoclastoma tumors are
complications
• Osteoarthritis are common associated with
pagets disease

22. Diagnostic investigation
• X rays – shows increased bone
expansion and density.
• Bone scan
• Serum alkaline phosphates levels
increased
• N-telopeptide and C-telopeptide
they are biomarkers used to
measure the rate of bone turnover,
can be measure from urine or serum

23. Management
• Limited to symptoms
• Supportive care
• Correction of secondary deformity
• Calcitonin – decrease osteoclastic activity

24. Bisphosphonate drugs –
• Risedronate, Tidronate, Pamidronate, Ibandronate
– retard bone resorption
Calcium and vitamin D supplements
• Pain – NSAIDS, ibuprofen.
• Orthopedic surgeries for fracture, hip and knee
replacements
• Firm mattress – back support and to relieve pain
• Wear light brace
• Activity like lifting and twisting should be avoided

25. • Physical therapy will increase muscle strength
• Good body mechanics
• Balanced nutrition programme – vit.D, calcium
and protein
• Massage, heat therapy
Prevention
• Patient education
• Use of an assistive device