Downloaded 211 times
Uploaded byDr.Sabyasachi Bardhan DNB (Ortho), MNAMS
Rickets & Osteomalacia
Rickets and osteomalacia are disorders caused by interrupted mineralization of bone due to calcium, phosphorus, and vitamin D metabolism issues. Rickets occurs in children and causes bone deformities, while osteomalacia occurs in adults. Various types of rickets include vitamin D deficiency, vitamin D dependent, and vitamin D resistant. Treatment involves vitamin D supplementation, calcium supplementation, and correcting fluid and electrolyte imbalances. Osteomalacia in adults is also caused by vitamin D deficiency and is treated with vitamin D supplementation.
More Related Content
Similar to Rickets & Osteomalacia
Rickets & Osteomalacia
- 1. DR. SABYASACHI BARDHAN RICKETS& OSTEOMALACIA
- 2. DEFINITION Interruption of orderlymineralisation and development of growth plate due to disorder in Ca, P & Vit D metablism
- 3. TYPES Vit Ddefficiency rickets: Nutritional, GI Vit D dependant rickets(VDDR) I: 1 alpha hydroxylase deff : Vit D3 not formed II: End organ resistance Vit D resistant rickets (VDRR) RTA: Prox & distal, Fanconi, Oncogenic, XLHR Phosphorus loss due to lack of absorption and increased secreation Renal osteodystrophy Renal parenchymal disorder (CKD) Phosphorus retention, Reduced Vit D3 production
- 5. NORMAL PHYSIOLOGY Boneconsists of protein matrix –osteoid Mineral phase-calcium and phosphorus. Intramembranous ossification-flat bones mesenchymal cells differentiate into osteoblasts Enchondral ossification –long tubular bones Growing cartilage at the epiphyseal plates is mineralized and resorbed and replaced by osteoid matrix which undergoes mineralization to create bone. IN RICKETS MINERALISATION IS INHIBITED AT THE ZONE OF PROVISIONAL CALCIFICATION
- 6. C/F •Irritability , profuse sweatingwhile asleep, hypotonia,frequent respiratory infections., Failure to thrive, Fits, tetany. •Delay in walking •Frontal bossing (due to excess osteoid), Craniotabes ,Delayed closure of anterior fontanel, delayed dentition • Rachitic Rosery Harrison’s sulcus, Pigeon chest deformity •Widening of wrists and ankles ,Bending of
- 7. RADIOLOGY •Illdefined epiphysis •Increased thickness ofphysis •Metaphyseal broadening/splaying •Cupping •Fraying •Thin cortices
- 8. LITMUS BLUETEST: Urinary ph low in RTA SULKOWITCH TEST: (Glacial acetic acid + Oxalic acid + Ammonium oxalate) + Distilled water + Equal vol urine -> calcium ppt Weigh the calcium, reflects blood Calcium level
- 9. BIOCHEMICAL PROFILE Ca PPTH ALP 25(OH) Vit D Vit D Defficienc y N/Low N/Low Increase d Increase d Low Ur P- low Vit D Dependa nt Low Low Increase d Increase d Normal Vit D resistant N/Low Low Normal Increase d D3 –N Ur P- High Renal Osteodyst rophy N/Low Increase d Increase d Increase d Normal D3- low
- 10. MEDICAL MANAGEMENT TYPES TREATMENT VitD deff 600000 IU/15000mcg IM/ 0.5 -2 mcg calcitriol/day orally + 500 mg Ca VDDR I 2-3mcg calcitriol / day orally + Ca supplementation VDDR II Poor prognosis 30 mcg calcitriol /day + Ca + Dihydrotachysterol VDRR 2-3 mcg calcitriol/ day orally + Ca+ NaH2PO4/Na2HPO4 Correction of fluid electrolyte imbalance, nutritional supplementation Renal Osteodystrophy 1-2 mcg calcitriol/ day orally + Ca Dialysis
- 11. Surgery is indicatedfor residual unacceptable deformities Hemiepiphysiodesis Osteotomy
- 12. HEALING RICKETS Zoneof provisional calcification becomes denser Epiphysis well defined Width of physis decreases
- 13. OSTEOMALACIA Vit Ddefficiency in adults (<20ng/ml; 21-29:Insufficiency) Aches and pains, muscle weakness loss of height, stress #s. Nutritional, GI disorder, Drugs (phenytoin, Phenobarbitone), Renal osteodystrophy X ray: Osteopoenia, coarse trabeculae, Looser’s zone Vit D supplementation regimen 50,000 IU of vitamin D2 or D3 once weekly for 8 weeks or 6000 IU/day of vitamin D2 or D3 for 8 weeks When the serum 25(OH)D level exceeds 30 ng/mL, provide maintenance treatment of 1500-2000 IU/day
- 14.