Osteomalacia And Rickets Notes

Osteomalacia and Rickets

Normal amount of bone but reduced mineral content

Rickets occurs if this happens during bone growth

Osteomalacia occurs if this happens after fusion of epiphyses.

Types

Vitamin D deficiency (dietary inadequacy, lack of sunlight or malabsorption)

Renal + liver osteomalacia (decreased hydroxylation of vit D)

Drug induced

Inherited vitamin D resistance

Clinical features

Rickets

• Knock-kneed

• Bow-legged

• Hypocalcaemia

• Enlargement of ends of long bones, widened cranial sutures

Osteomalacia

• Bone pain (proximal limb girdles and lower back)

• Fractures

• Proximal myopathy

• Decreased phosphate

Investigations

Bloods: low calcium, phosphate. Increased alk phos, PTH. Decreased vit D

Biopsy: shows poor mineralisation

Xray

• In Rickets – cupped metaphyseal surfaces

• In Osteomalacia – Looser’s zones/pseudofractures = translucent bands at sites of stress e.g ribs, scapula + pubic rami

Management

• Treat any underlying cause

• Give oral daily vit D supplements

• Hydroxylated supplements if renal/liver disease

• Treatments relieve symptoms and correct bony abnormality in 3-4 months

Osteoporosis

Skeletal abnormality characterized by compromised bone strength predisposing to an increased risk of fracture

Risk Factors

• Most common in elderly woman – particularly those with late menarche, early menopause

• Smoking

• Alcohol

• Sedentary lifestyle

• Fam hx

Secondary osteoporosis due to

• Endocrine diseases (cushings, thyrotoxicosis, hyperparathyroidism)

• Rheumatology (inflammatory arthropathies)

• GI e.g liver cirrhosis,...

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