Aetiology of osteomalacia and its dietary management

Introduction

Oesteomalacia is the weakening of the bone due to problem with bone formation or bones building process. It is not the same as osteporosis which is the weakening of living bone that has already been formed and is being remodeled, oesteomalacia occurs as a result of vitamin deficiency, deficiency of calcium and phosphorus etc.

The clinical features diagnose, treatment of oesteomalacia are discussed in related recognized cases. The disease is common in elderly women than in men. Symptom of oesteomalacia includes bone pain which occur in the arms, legs and spine.

Bones need calcium and phosphorus to remain healthy and strong. The body also needs vitamin D to be able to absorb these too mineral, without the necessary vitamins, bone can become soft and flexible the softness is called osteomalacia in adult while in children, it is called rickets. Oestemalacia on bone softening occurs after the growth plates have closed.

Oestomalacia is deriving from Greek word “osteo” which mean bone and “malacia” means softness.  In the past, the diseases was also known as (malacosteon) and its Latin derived (mollities ossium)

Definition of oesteomalacia

According to Mosley’s Medical Dictionary 8^th edition (2009), oesteomalacia is the softening of bones caused by defective bone mineralization secondary to inadequate amount of available phosphorus and calcium or over action re-absorption of calcium from bone as result of hyperthyroidism  (which causes hypercalcemia in contrast to other aetiologies)

Anwuli (2014), defines osteomalacia as the softening of bone arises when there is a vitamin D deficiency in adult, rickets in children, since vitamin D is necessary for the absorption of calcium to demineralization of bones. Demineralization of bones occurs when the bone lost minerals, calcium, phosphorus etc and it makes it to be soft.

 Causes of osteomalacia

The most common causes of includes

1. Lack of vitamin D (calcium and phosphorus)
2. Chronic renal failure and complication of hemodialysis are potential cause
3. Stomach surgery
4. Malnutrition during pregnancy
5. Vary rail tumour
6. Chronic kidney failure
7. Having a dark skin
8. Intestinal disorder

 Signs and symptoms of oestomalacia

1. Muscle weakness due to problem of the location where the muscle attached to bone
2. Having a hard time walking and may develop a waddling gait
3. Bone pain especially in the hip is also a very common symptom
4. Chronic acidosis (an abnormal state of reducing alkalinity)
5. Weak bone
6. Spinal bone pain
7. Leg bone pain
8. Pelvic bone pain pelvic flattening
9. Fragility of the bone
10. Easy fracturing
11. Compressed vertebrae

Diagnosis of oesteomalacia

Because the symptoms of osteomalacia is often not specific, it can be sometimes before the condition is diagnosed. As a dietician you can ask a patient about the diet intake and family history of bone diseases. It is common for people to have oesteomalacia for 2 to 3 years before it diagnose. It can be diagnose through the following (C.T) computer Tomography) scans of the spine piece of bone to show changes on the vertebrae.

• A bone biopsy- A needle is inserted into the bone to allow the doctor to remove a small piece of bone tissue for analysis.
• Kidney function and urine taste
• Blood tests to measure level of calcium phosphatic and vitamins.
• The use of x-rays image of the leg bone to look for abnormities such as pelvic may also changes in the vertebrae.

 Treatment for oesteomalacia

If detected early treatment can be simple and taking oral supplement for vitamin D. calcium or phosphate. If you have absorption problem, due to intestinal injury or surgery or have a diet low on the nutrient, this may be the first line at line treatment in rare cases.

Vitamin D may be administer as an injection through skin or intravenously through a vein in your arm, you may also be asked to spend some time out door in sunlight for your body to make sufficient vitamin D metabolism they need to be treatment.

Kidney failure most be treated to reduce asteomalacia in adult and rickets in children. Children may have to wear race determination in severe cases of oesteomalacia in adult and rickets in children.

Clinical feature of oesteomalacia

1. Pains at the ribs and legs
2. Bone tenderness in pressure is common
3. Muscles weakness and the patient may find it difficult in climbing stars or putting out a chair.
4. The patient may walk with it feet widely separated and this may led to wadding gait waddle
5. Aches and pain in the lumbar (lower back)
6. Pathological fatty is due to weight bearing may developed

 Dietary management of oesteomalacia

Oesteomalcia caused by inadequate sun exposure or diet low in vitamin D, therefore eating the recommended as follow, will help in rectifying these problems.

Eat food high in vitamin D which includes oily fish, salmon, mackerel, sardines, egg yolk

Also look for food that are fortified with vitamin D, such as cereal, bread, milk and yoghurt

Take supplement if need. If you don’t eat enough vitamin and minerals you need supplement as follow:

1. Calcium supplement of 500-100 mg (milligram)
2. Normal calcium intake from your normal diet is 750 mg per day

Patients should be given daily supplement.

 Conclusion

• Vitamin D deficiency is the most common cause of oesteomalacia.
• Patient frequently complain of diffuse bone pain will as a result of limited sunlight exposure.
• Proximal muscle weakness, spinal tenderness to percussion, skeletal deformities is found commonly.
• Diagnosis is made via laboratory result which helps a low vitamin D level in the setting of low or normal calcium and an elevated intake.
• Once the underlying cause is addressed, a successful treatment requirement is possible. Increase sunlight exposure, oil vitamin D and calcium replacement.

References

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