Osteomalacia

Osteomalacia is a discomforting condition that affects many people around the world and is said to affect one out of every 1000 people in the United States. Read and know all about Osteomalacia along with its causes, symptoms, diagnosis and treatment.

Osteomalacia Definition

Medical researchers define Osteomalacia as a condition that causes softening of the bones of an adult, thereby leading to discomforting problems like bone pain and muscular weakness.

Osteomalacia Incidence

The condition reportedly affects about 20 to 25 million people in the U.S. This includes 25 percent women who are over menopausal age.

Osteomalacia Symptoms

In the initial stages, patients do not experience any symptoms. However, these signs may be apparent on diagnostic tests such as X-ray imaging. In some cases, symptoms are very obscure though patients may suffer from pains and a general sense of ill-feeling. As the condition worsens, patients may experience symptoms like:

Bone pain

This is a common symptom that gradually arises and persists in most patients. But in acute cases, there can be painful symptoms in all the bones. Bone pain is usually dull in intensity and mostly originates in lower spine, pelvis, hips, legs, ribs and lower back. In many patients, bone pain is widespread and particularly arises in the hips.

Bone tenderness

Even minor pressure can give rise to pain in the bones. Aches are often experienced more in the shin bones or ribs. In some cases, pain and tenderness can result from hairline fracture in the bones. In some patients, bone fractures may occur with very minor injury.

Muscle weakness

It is frequently exhibited in the form of difficulties getting up from a low chair or floor or in climbing stairs. Some patients with this condition walk in a ‘waddling’ gait due to muscular fatigue. The problem may be accompanied by weakness in arms and legs, decreased motility and reduced muscle tone.

In some patients, reduced calcium levels may give rise to various symptoms like:

• Abnormal heart rhythms
• Numbness in arms, legs and around the mouth
• Spasms in muscles of hands or feet

Osteomalacia Causes

The condition may occur due to various causes, which mainly include lack of substantial nutrients in the diet and therefore the body itself. It may also occur if the body fails to absorb essential minerals in the diet properly. These troubles may be caused by:

Calcium deficiency

In patients with this disease, the softer bones are found to have a healthy amount of collagen. It is collagen that renders shape to the bones. The body uses phosphate and calcium to build strong bones. Weakness and softness in bones mainly result from a lack of enough calcium.

Lack of Vitamin D

Vitamin D is an essential substance that the body requires to process calcium. On exposure to sunlight the skin produces Vitamin D. Not spending enough time in sunlight can result in a Vitamin D deficiency. The problem can also occur in people who remain covered while moving about outside, wear very strong sunscreen or reside in areas which receive sunlight for only a few hours. The inadequacy is also observed in people living in regions with soggy air conditions.

Surgeries

The disorder may also arise after a few surgical procedures, such as Gastrectomy. This operative procedure involves partial or complete removal of the stomach. The stomach decomposes foods to release vitamin D and various essential minerals, which are absorbed in the intestines. Operative removal of the stomach can naturally lead to Osteomalacia. Surgical removal or shunting (bypass) of the small intestine can also result in this problem.

Celiac disease

This is an autoimmune disorder that is characterized by damage to the lining of the small intestine. In this case, damaged is caused by consumption of foods that are rich in Gluten, a protein component present in barley, rye and wheat. A healthy intestinal lining absorbs nutrients like vitamin D and helps build a strong body. A damaged lining fails to do this properly.

Liver or Kidney disorders

Problems arising in the kidneys or liver can intervene with the natural ability of the body to process vitamin D. Liver disease; kidney failure and acidosis are common causes of Osteomalacia.

Drugs

The disorder may also arise as a side effect from use of certain anti-seizure drugs. These include medications like Phenobarbital and Phenytoin (Phenytek, Dilantin).

Osteomalacia may also result from other conditions like:

• Cancer
• Acquired or hereditary disorders involving Vitamin D metabolism
• Phosphate depletion, resulting from lack of enough phosphates in the diet

Osteomalacia Risk Factors

The risk of development of this condition is highest in

• People who consume less Vitamin D in their diet
• Individuals with little exposure to sunlight
• Adults who are old in age
• Hospitalized or housebound individuals, with minimum activity
• Children and adults who avoid drinking milk

Osteomalacia Diagnosis

The detection of this condition involves diagnostic examinations like:

Blood and urine tests

If the condition results from vitamins or minerals, blood and urine tests will help detect any abnormalities in the level of Creatinine, Phosphate, Calcium and Vitamin D. Doctors often use a 24-hour urinary phosphate test to check for the presence of the condition.

X-ray

X-rays can help detect slight cracks in the bones that are known as looser transformation zones. These cracks are evident in many people with Osteomalacia. Bone X-rays, as well as Bone Density tests, help diagnose problems like bone loss, bone softening and Pseudofractures.

Bone biopsy

This important test reveals bone softening. In this process, doctors push a thin needle through the skin and into the bone to draw out a tiny sample that can be viewed under a microscope. Even though it is very exact in detecting the condition, this test is required only rarely for making a diagnosis.

PTH and ALP (alkaline phosphatase) isoenzyme are two other tests that can successfully evaluate whether Osteomalacia arises from a kidney disorder or some other underlying condition.

Osteomalacia and Bone Density Test

This condition often leads to a reduced bone density in patients. On bone density scanning, some Osteomalacia sufferers are frequently diagnosed with low bone density. A bone mineral density (BMD) test evaluates the amount of calcium and other minerals present in a patient’s bone segment. Physicians can use this test as well as other risk factors to tell whether a patient can suffer from bone fractures and osteoporosis in future. Bone mineral density scans employ a specific type of x-ray that determines the amount of calcium and other minerals inside bones of the body. The more the amount of minerals, the stronger the bones are. Patients with lower mineral content suffer from weaker bones.

Patients may undergo a bone density scan in a hospital or even privately. In some countries, there is restricted access to bone density scans. However, a doctor can arrange for this test if patients can get a private bone density scanner. Presently, DEXA (Dual Energy Xray Absorptiometry) is the most commonly used test to measure bone density.

Osteomalacia Differential Diagnosis

The differential diagnosis of Osteomalacia aims at ensuring that the discomforting symptoms experienced by individuals are not due to other underlying bone disorders, such as Paget’s disease and Osteoporosis.

Osteomalacia Treatment

Treatment of this disease may involve oral intake of supplements of Phosphorus, Calcium or Vitamin D. In individuals who fail to absorb nutrients properly into their intestines, calcium and vitamin D should be supplied in large doses. Vitamin D can be supplied into the body through an intravenous injection. It may also be administered through use of supplements that should be taken in for several weeks or months by mouth.

When Osteomalacia arises from a sunlight or dietary deficiency, the condition can be cured by replenishing vitamin D levels in the body. If any condition, such as Primary Biliary Cirrhosis or Kidney failure, affects vitamin D metabolism treating them often helps improve the symptoms of Osteomalacia.

In people with some underlying conditions, regular blood tests may be required to monitor levels of calcium and phosphorus in the bloodstream.

Osteomalacia Prognosis

The condition usually has a good outcome. In some patients with vitamin deficiency disorders, the condition may progress within a few weeks. With treatment, complete healing occurs in around six months.

Osteomalacia Complications

Recurrence of the condition is a possible complication. Patients with this disorder may also suffer from broken bones, especially in the spine, ribs and legs. Medical attention should be immediately sought in such cases.

Osteomalacia in Children

In children, this condition is generally known as “Rickets”. It usually results from reduced levels of vitamin D. Low vitamin D level is one of the main causative factors in people who are susceptible to suffer from soft bones. In children suffering from this disorder, the cause may be associated to dietary, genetic or environmental sources.

Osteomalacia Prevention

Osteomalacia may be avoided by using various preventive measures, such as:

Dietary modifications

Add more Vitamin D-rich foods into your diet, such as egg yolks, cereal, milk, yogurt bread, and oily fishes (such as sardines, mackerel and salmon). These foods are naturally rich in vitamin D.

Increased exposure to sun

As aforesaid, inadequate exposure to sun can be one of the primary causes of this condition. Sunlight is a natural source of Vitamin D. Spending sometime under sunlight can help boost Vitamin D production in the body. However, it is better to consult a skin expert or a dermatologist to know how much time you should ideally spend under the sun. Long periods of direct sun exposure can harm the skin rather than boosting its health.

Supplements

Ask your doctor whether you should consume calcium or vitamin D supplements. If you do not have enough time to follow a diet, these supplements can be very useful. The supplements may also be helpful if you have a medical condition that affects the power of your digestive system to properly absorb nutrients.

Osteomalacia Vs Osteoporosis

Osteomalacia is often confused with Osteoporosis, a complicated condition caused by abnormal loss of bony tissue resulting from a lack of calcium in the body. The condition is very common in post-menopausal women and occurs due to afflicted mineralization. However, Osteomalacia usually arises due to abnormal vitamin D metabolism or severe vitamin D deficiency. Osteoporosis can occur due to mild to moderate deficiency in vitamin D levels and results in fragile porous bones.

Oncogenic Osteomalacia

Oncogenic osteomalacia, is an acquired, paraneoplastic syndrome of renal phosphate-wasting that resembles genetic forms of hypophosphatemic rickets. this unusal disease, also known as tumor-induced osteomalacia. It is one of the most interesting paraneoplastic syndromes. The tumors are usually benign, vascular, small mesencymal tumors such as hemangiomas, that are difficult to locate. They frequently are found in area of the sinuses, some are in bone or skin. A few cases of metastatic prostate carcinoma and small cell carcinoma have also been assoicated with low phosphate and osteomalacia. Myeloma with light chain nephropathy can cause hypophosphatemia but this is a form of Fanconi’s syndrome and does not have the same pathophysiology. The tumors can occur at any age in both genders. It may take longer than a decade to locate them.

Patients present with muscle weakness, bone pain, or fractures. Children will have rickets (bowing at the knees). Xrays disclose osteopenia, Looser’s zones or wide epiphyseal plates. Bone scans may show multiple lesions, and increased activity at the ends of the ribs resembles the “rachetic rosary” seen with vitamin D deficiency.

Seek prompt medical care if you are being treated for Osteomalacia but mild symptoms, such as numbness, swelling, or trouble moving your joints, recur or are persistent. In some cases, Osteomalacia can lead to serious bone fractures and should be treated. Seek immediate medical care (call 911) if your Osteomalacia includes serious signs and symptoms, such as deformity or dislocation of a joint, extensive swelling, numbness, bone protruding through the skin, or inability to feel the bone.

References:

http://www.mayoclinic.com/health/osteomalacia/DS00935

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001414/

http://www.patient.co.uk/health/Osteomalacia.htm

http://www.bettermedicine.com/article/osteomalacia