What is Osteomalacia?
Bones are responsible for providing rigidity and strength to our body. They facilitate movements and protect internal organs.
Osteomalacia or Nutritional Osteomalacia refers to the softening of the bone tissue. In this disease, due to impairment in the bone formation process particularly the mineralization step (deposition of minerals like calcium, phosphorous, etc. in the protein framework of the bone), the bones become weak and more susceptible to deformities and fractures.
The condition is said to be mainly caused by the deficiency of vitamin D which is important for maintaining calcium in our bones.
Understanding the ailment
The bone is made of 2 parts: the protein part or the osteoid and the mineral part.
The mineral part mainly constitutes of calcium and phosphorus and is responsible for providing hardness and strength to the bones.
In osteomalacia, the mineralization of bone is impaired and hence the soft osteoid accumulates.
What are the symptoms of Osteomalacia?
The symptoms of this condition are highly variable. Thus given their vague nature, the disease is usually not diagnosed in its early stages.
Common symptoms include:
- Pain which increases on excessive usage and persists even after rest. This is the earliest symptom.
- The pain is usually dull aching especially in the hips and gradually spreads to the lower back, legs and ribs.
- Difficulty in rising from the chair
- Difficulty in climbing stairs
- Clumsy gait
Patients who have low blood calcium levels may also experience:
- Stiffness in muscles
- Pins and needles sensation on face and hands
What are the causes of Osteomalacia?
Vitamin D deficiency is said to be the main cause of osteomalacia.
Sunlight is the main source of vitamin D and hence decreased exposure to it is said to be the predominant cause of vitamin D deficiency in osteomalacia.
Vitamin D formation also involves the role of kidney and liver hence any impairment of these organs will also lead to a deficiency of this vitamin.
Decreased dietary intake and impaired absorption from the digestive system are also some of the causes.
Other causes of osteomalacia include decreased levels of calcium, phosphate or magnesium in the blood.
What are the risk factors for Osteomalacia?
- Housebound and institutionalized elderly since they have decreased exposure to sun and hence less vitamin D
- Severe liver disease
- Renal impairment
- Patients on antiepileptic drugs like phenytoin
- Patients who have had gastric surgery (it may lead to impaired absorption of dietary vitamin D)
How is Osteomalacia diagnosed?
Here are the laboratory tests:
- Serum calcium
- Urine calcium
- Serum phosphates
- Serum Vitamin D
- Serum alkaline phosphatase levels
- Kidney function test
- Liver function test
- Serum parathormone levels
- X-ray examination
- Bone mineral density scan (BMD)
How is Osteomalacia treated?
Vitamin D is available in various chemical forms which are prescribed to the patients according to their underlying condition.
For eg. Patients who have impaired absorption of the vitamin will receive a different chemical form of the vitamin as compared to those who do not suffer from this condition.
Also Read: How to treat Nutritional Osteomalacia
Treating vitamin D deficiency osteomalacia
Ultraviolet radiation therapy or vitamin D supplementation is usually employed. The patient is prescribed combined vitamin D and calcium supplements. They may also be asked to increase their time outside in the sun.
Treating osteomalacia due to malabsorption and gastric surgery
Appropriate supplements will be prescribed to the patients. They will also be given antibiotic therapy, dietary recommendations if necessary. Magnesium supplements can also be given in case of decreased blood magnesium levels.
Treating osteomalacia due to liver and renal impairment
The disease is treated along with appropriate supplementation is prescribed to the patients. It is important for the patients to get their blood calcium levels routinely checked to prevent side effects due to excess calcium in the blood.
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