OSTEOMALACIA - Causes, Pathophysiology, Clinical Manifestations, Diagnostic Evaluations, Medical Management and Nursing Management
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OSTEOMALACIA - Causes, Pathophysiology, Clinical Manifestations, Diagnostic Evaluations, Medical Management and Nursing Management 

OSTEOMALACIA - Causes, Pathophysiology, Clinical Manifestations, Diagnostic Evaluations, Medical Management and Nursing Management

Osteomalacia means “soft bones”. Osteomalacia is metabolic bone disorder characterized by inadequate, delayed or defective mineralization of bone matrix in mature compact or spongy bone. In children, it is known as rickets. Osteomalacia is a disease that weakens bones and can cause them to break more easily. The bone tends to break down faster than it can re-reform. As a result of calcium deficiency, muscle weakness, and unsteadiness, there is an increased risk for falls and fractures.

CAUSES OF OSTEOMALACIA


  • Vitamin D deficiency due to decreased dietary intake, lack of sun exposure, renal or liver disorders, malabsorption from intestines and gastrectomy.
  • Phosphate depeletion due to inadequate intake
  • Systematic acidosis in renal tubular acidosis.
  • Celiac disease
  • Chronic renal failure
  • Calcium malabsorption
  • Prolonged use of antacids and drugs used to treat seizures, including phenytoin and Phenobarbital


 

PATHOPHYSIOLOGY

The softer bones in osteomalacia have a normal amount of collagen, which gives the bones its structure. They lack proper amount of calcium and usually caused by low levels of vitamin D

 

Due to etiological factors ---- DECREASED LEVEL OF VITAMIN D  ----- decreased absorption of calcium and phosphorus from intestines -------- serum level of calcium and phosphorus decreases ---- activate parathyroid gland -----  RESULTS IN CONTINUOUS LOSS OF CALCIUM AND PHOSPHORUS FROM BONE  ----  impaired mineralization in spongy or compact bones  ------ DEFORMITY OF LONG BONES, SPINE, PELVIC AND SKULL  ----- Bone becomes soft and unable to bear stress and weight  ------ OSTEOMALACIA

 

CLINICAL MANIFESTATIONS

  • Bone fractures that happen without a real injury
  • Progressive muscle weakness and tenderness
  • Widespread bone pain, especially in the hips
  • Leg and lower back pain due to vertebral collapse
  • Bowing of bones – dorsal kyphosis
  • Progressive deformities of bones of extremities and spine
  • Difficulty in changing position lying to sitting position and sitting to standing position
  • Enlarged wrists and ankles
  • Pigeon breast (protruding ribs and sternum)
  • Difficulty walking and climbing stairs
  • Kyphoscoliosis


Symptoms may also due to low calcium levels. These include:

  • Numbness around the mouth
  • Numbness of the arms and legs
  • Spasms of the hands or feet


 

DIAGNOSTIC EVALUATIONS

  • Blood tests will be done to check vitamin D, creatinine, calcium and phosphate levels
  • Urine test to detect calcium and creatinine
  • Bone biopsy will show bone softening
  • X-rays and a bone density test can help detect pseudofracture, bone loss, and bone softening
  • ALF (alkaline phosphatase) isoenzyme test
  • PTH test


MEDICAL MANAGEMENT


  1. Generally, people with osteomalacia take vitamin D, calcium and phosphorus supplements by mouth for a period of several weeks to several months
  2. People who cannot properly absorb nutrients through the intestines may need larger doses of vitamin D and calcium
  3. Exposures to sunlight also prescribed to patient
  4. Provide a diet with adequate protein and increased calcium and vitamin D (e.g., fortified milk and cereals, eggs, chicken livers)
  5. Safe use of vitamin D supplements recommended as higher doses are toxic as it increases the level of calcium
  6. Treating any condition affecting vitamin D metabolism, such as kidney disease or low phosphate levels, often helps improve the signs and symptoms of osteomalacia​


NURSING MANAGEMENT

  1. Advice the patient about intake of diet rich in calcium and phosphorus
  2. Teach about safety measures to prevent falls i.e. proper light in bathroom, hallways and avoid slippery floors and use of grab rails in bathrooms for shower and bath tubs and toilet seats
  3. Reduce the patient’s discomfort and pain. Assist the patient to change positions, handles the patient gently, and pillows are used to support the body
  4. Encourage the patient towards use of assistive devices – walkers sticks, canes or crutches while ambulating
  5. Teach the patient to observe anorexia, nausea/vomiting, frequent urination, muscle weakness and constipation as these are the systems of vitamin D toxicity. It exists, concern the physician.
  6. Instruct the patient to focus on careful positioning, ambulation, and prescribed exercises.
  7. Teach client how to use ambulatory device with physical therapist’s assistance as necessary
  8. Teach client about high fracture risk even with minor trauma related to fragile bone status