Osteomalacia

Many of the effects of the disease overlap with the more common osteoporosis, but both diseases are significantly different. Osteomalacia in adults starts insidiously as aches and pains in the lumbar (lower back) region and thighs before spreading to the arms and ribs. The pain is symmetrical, non-radiating and accompanied by sensitivity in the involved bones. Proximal muscles are weak, and there is difficulty in climbing upstairs and getting up from a squatting position. and lordosis. The patient has a typical "waddling" gait. However, these physical signs may derive from a previous osteomalacial state, since bones do not regain their original shape after they become deformed. Pathologic fractures due to weight bearing may develop. Most of the time, the only alleged symptom is chronic fatigue, while bone aches are not spontaneous but only revealed by pressure or shocks. It differs from renal osteodystrophy, where the latter shows hyperphosphatemia. == Causes ==

The causes of adult osteomalacia are varied, but ultimately result in a vitamin D deficiency: There are two main mechanisms of osteomalacia: • insufficient calcium absorption from the intestine because of lack of dietary calcium or a deficiency of, or resistance to, the action of vitamin D, or due to undiagnosed celiac disease. • phosphate deficiency caused by increased renal losses. == Diagnosis ==

Biochemical findings Biochemical features are similar to those of rickets. The major factor is an abnormally low vitamin D concentration in blood serum. • Low serum and urinary calcium • Low serum phosphate, except in cases of renal osteodystrophy • Elevated serum alkaline phosphatase (due to an increase in compensatory osteoblast activity) • Elevated parathyroid hormone (due to low calcium) Furthermore, a technetium bone scan will show increased activity (also due to increased osteoblasts). Radiographic characteristics Radiological appearances include: • Pseudofractures, also called Looser's zones • Protrusio acetabuli, a hip joint disorder == Prevention ==

Prevention of osteomalacia rests on having an adequate intake of vitamin D and calcium, or other treatments if the osteomalacia hereditary (genetic). Vitamin D3 Supplementation is often needed due to the scarcity of Vitamin D sources in the modern diet. == Treatment ==

Nutritional osteomalacia responds well to administration of 2,000-10,000 IU of vitamin D3 by mouth daily. Vitamin D3 (cholecalciferol) is typically absorbed more readily than vitamin D2 (ergocalciferol). Osteomalacia due to malabsorption may require treatment by injection or daily oral dosing of significant amounts of vitamin D3. == Etymology ==

Osteomalacia is derived from Greek: osteo- which means "bone", and malacia which means "softness". In the past, the disease was also known as malacosteon and its Latin-derived equivalent, mollities ossium. Osteomalacia is associated with increase in osteoid maturation time. == See also ==