Osteomalacia is a condition in which there is a softening of the bones. This occurs as a result of the impairment of the metabolism of the bones, which might be as a result of an insufficient amount of mineral elements such as phosphate, calcium and vitamin D. This condition is referred to as rickets when it occurs in children. Some of the signs and symptoms of osteomalacia include generalized body pains, fatigue of the muscles, the fragility of the bones and so on. Osteomalacia might occur as a result of many factors. However, the most prevalent cause of this disease is the deficiency of Vitamin D. Other causes of the disease include hereditary deficiencies of Vitamin D or phosphate. This disease is diagnosed by evaluating the patient for serum 25(OH)D level. Vitamin D and supplements such as calcium can be used to prevent and successfully manage this disease. Vitamin D is always prescribed in combination with calcium. Some of the risk factors of osteomalacia include a low exposure to sunlight. The body needs sunlight to properly synthesize vitamin D. Other risk factors include persons that have undergone gastrointestinal bypass surgery or celiac disease. Lastly, people that migrated from hot climates to cold regions have a high risk of developing osteomalacia. Patients are given calcium and vitamin supplements for the treatment of this disease. Researchers are working on ways to use shockwave therapy to treat this disease.
What Are the Signs and Symptoms Of Osteomalacia?
People affected by osteomalacia might not present with any symptoms in the initial stage of the disease. Although there might be some signs of osteomalacia on the imaging tests, such as the X-ray. However, patients start manifesting symptoms as the disease progresses. Below are some of the symptoms;
- Patients might present with diffused pain of the joints, and the bone. This tends to occur more in the joints of the spine, pelvis and leg bones. The pain might be worse at night, or when some pressure is applied to the bones.
- Persons affected with this disease usually presents with weakness of the muscle.
- Bending of the bones.
- Brittle bones: The bones of persons affected with this disease tend to fracture easily.
- Patients might have difficulty walking, and some might present with a waddling This is due to the reduced muscle tone.
- Compression of the vertebrae, and reduced stature.
- Patients might also present with the flattening of their pelvis.
What Are The Causes Of Osteomalacia?
Osteomalacia occurs due to a defect in the maturing process of bones. Usually, the body makes use of elements like calcium, phosphate and so on in the development of healthy and strong bones. However, osteomalacia occurs when these elements are not sufficient, or when the body doesn’t absorb an adequate amount of the elements. Below are some of the cause of osteomalacia;
- Deficiency Of Vitamin D: This mostly occur in people that don’t get enough exposure to sunlight. This is important because sunlight is needed for the production of vitamin D in the skin. Individuals that live in areas, with a low amount of sunlight, and also people that consume a diet that is low in Vitamin D, have a high risk of developing osteomalacia. Studies have shown that the deficiency of Vitamin D, is the most prevalent cause of osteomalacia globally.
- Surgeries: Surgeries in which some parts or all of the stomach is removed can lead to the insufficient absorption of vitamin D and calcium into the body. Normally, the stomach helps in the breakdown of food to release nutrients and elements that the body needs to function well. The total resection or partial removal of parts of the intestine and stomach can predispose people to conditions like osteomalacia.
- Celiac disease: Celiac disease is a chronic autoimmune disease that affects the small intestine. This disease occurs as a result of an immune reaction to gluten. Gluten is a component of some protein foods, such as wheat and barley. This disease occurs in people that are genetically predisposed to having the disease. The typical symptoms of this disease include long-term diarrhoea, reduced or the loss of appetite, growth retardation, malabsorption and the distention of the abdomen. This disease typically occurs when people are between the 6 months and 2 years. When an individual with celiac disease consumes food that has gluten, the immune system of the body attacks the gluten and damages the villi in the process. The villi are projections in the small intestine, that enhances the absorption of food. However, celiac disease would present with malabsorption because of the damages were done to the villi by the body immune system. This can eventually lead to the loss of some important In addition, patients might experience a reduced bone density, infertility, problems digesting fat food, and so on. The damage of the intestinal lining would eventually lead to the malabsorption of elements like calcium, and vitamin D. This would predispose the patient to develop osteomalacia.
- Renal and hepatic disorder: People that have a disorder of the liver and kidney would also have a problem activating vitamin D, in the body. This is because these two organs are needed for the synthesis of vitamin D.
- Medications: There are some medications that can lead to the development of osteomalacia. Some of the drugs are anti-seizure medications. Examples of this drugs include phenytoin, phenobarbital and so on. They can lead to vitamin D deficiency and osteomalacia.
How Is Osteomalacia Diagnosed?
Physicians do diagnose this disease by first, taking the medical and personal history of the patient. If the doctor notices that there might be a chance the patient has osteomalacia, further evaluations are done. Some of the evaluations include medical imaging. This includes X-ray, CT SCAN, MRI and so on. Bone biopsy might be done in rare cases. This is usually done under general anaesthesia. The physician would insert a needle into the bone, and extract samples of the patient’s bone tissue. Bone biopsy is accurate, although it’s rarely done. The X-ray of the disease usually appears normal initially, however, cracks in the bones might become visible as the disease progresses.
Treatment
Patients are given vitamin D supplements for a long duration. This might range from weeks to months. Physicians would also advise patients to increase their intake of calcium and phosphate-containing food and supplements.
References
Luisetto, G., Camozzi, V., De Terlizzi, F., Moschini, G., & Ballanti, P. (1999). Use of ultrasonography in the diagnosis of osteomalacia: preliminary results on experimental osteomalacia in the rat. Journal Of Ultrasound In Medicine, 18(3), 225-229. doi: 10.7863/jum.1999.18.3.225
MEULENGRACHT, E. (2009). Osteomalacia of the Spinal Column from Deficient Diet or from Disease of the Digestive Tract. Acta Medica Scandinavica, 101(2-3), 187-210. doi: 10.1111/j.0954-6820.1939.tb07784.x