X-rayof a 60 years old female.

Proceed!

Osteomalacia

Dr. Bilal ahmadPG TraineeMTI LRH

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

Contents Introduction EpidemiologyPathophysiologyCauses Presentation Diagnosis Differentials Management Summary References

Introduction

Definition Metabolic disease characterized by inadequate and delayed mineralization ofosteoid in mature compact and spongy bone.

Bone compositionThe Matrix Organic components (40% )Mostly collagen Inorganic components (60%) calciumphosphate

The cells Osteoblasts /osteocytes / osteoclasts

Normal daily requirment of calcium is 1000 mg / day. . .. 99% of calcium is present in the bone 7

Bone mineralization Bone Mineral Hydroxyapatite[Ca10(PO4)6(OH)2]

Vitamin D(Metabolism)

Vitamin D(Functions)

*Intestinal Calcium absorption

*Re-absorption of Calcium from Kidneys

*Interaction with PTH in regulation of blood Calcium

*Mineralization of Bone

Epidemiology

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.

Causes Deficiency of vitamin DDietrySun exposure

This 10 microgram is equal to 400 IU / day12

Gastrointestinal CausesGastricIntestinalBilliary

Renal CausesChronic Renal FailureRenal Tubular AcidosisLong term Renal DialysisFanconi Syndrome(Poisoning)

Tumor Induced OsteomalaciaFGF23 DrugsPhenytoin PhenobarbitalCarbamazepine Acetazolamide Aluminium Compound Flouride

Presentation >50yrs ageBone PainMuscle WeaknessKyphosis/scoliosisWaddling gaitEasy Fractures

Examination Muscle weaknessBone tendernessTetanyWidening of wristsSkeletal deformities

Lab investigations CBCElectrolytesLevels Of CalciumPhosphorusCalcium Phosphorus IndexVitamin DALPPTH

Findings ..Low serum Vit. DLow serum and urine Ca levelsElevated Serum and urinary Alkaline PhosphataseLow serum phosphate except in case of Renal OsteodystrophyElevated PTH due to low calcium

Radiological findings

Fractures.Pseudofractures, also called Loosers Zones.Codfish vertebrae.Protrusio Acetabuli, a hip joint disorder.

Fracture

Loosers zone

Codfish vertebrae..

Protrusio acetabuli..

Differentials HypophosphatasiaJansen SyndromeSevere Calcium deficiencySevere Phosphorus deficiency

Hypophosphotasia diagnosis >> 24 hours urine assay for phosphoethanolamine , a substrate for tissue non specific alkaline phosphatase, whose excretion is always elevated in hypophosphatasia.25

Complications Respiratory: Infections or atelectasis due to chest deformities. GIT: Constipation Bony deformities: Or fracturesAnemia: Due to chronic infection or deficiencies.

Management Primary preventionAdequate sun exposureDiet rich in calciumTreatment of underlining conditions/dieseases

ContinuePharmacological treatmentNutritional 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.

Question ..Which statement is true regarding Vit-D functionIncrease GI Calcium and phosphate absorpOnly phophate absorptionOnly calcium absorption

Question..How much Asian adults are Vit-D deficient

1 in 5

1 in 8

1 in 3

Question ..Which of the following drug/s can cause Vit-D def

(a) Carbamazepine

(b) Phenytion

Only option a

Both a and b

Question ..Most common cause of osteomalacia is

Vit-D deficiency

Calcium deficiency

Phosphate deficiency

Question ..Most common presentation of osteomalacia is

Carpopedal spasm (tetany)

Bone pain and tenderness

Muscle weakness

Question ..Serum phosphate level is low in all causes of Osteomalacia except

Tumor induced osteomalacia

Renal osteodystrophy

Fanconi syndrome

References http://painreliveonlypt.blogspot.com/2014/10/osteomalacia-causes-risk-factors.htmlhttp://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/

Acknowledgement Dr. Farooq ahmed

Thank you