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CONDITION/DISORDER SYNONYM

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  • Rickets

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ICD-9-CM CODE1

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  • 268.2 Osteomalacia unspecified

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ICD-10-CM CODE2

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  • M83.9 Adult osteomalacia, unspecified

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PREFERRED PRACTICE PATTERNS3

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  • 4A: Primary Prevention/Risk Reduction for Skeletal Demineralization

  • 4B: Impaired Posture

  • 4C: Impaired Muscle Performance

  • 4F: Impaired joint Mobility, Motor Function, Muscle Performance, ROM and Reflex Integrity Association with Spinal Disorders

  • 4G: Impaired Joint Mobility, Muscle Performance, and ROM Associated with Fracture

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PATIENT PRESENTATION

A 60-year-old female patient presents with right transfemoral hip fracture s/p ORIF. She reported the fracture occurred when she was walking down the stairs and she missed the last step. No fall occurred. Prior to the fracture she reports she was having bone pain in both lower extremities and that her legs were feeling weaker than normal.

Her orthopedic surgeon refers her to physical therapy. Her weight-bearing status is weight bearing as tolerated and she ambulates with a standard walker. On physical therapy examination, she has noticeable weakness and muscular atrophy in both lower extremities, right > left. She is a very thin woman with an increased thoracic kyphosis. Manual muscle testing revealed overall right hip strength 3/5, with the exception of 2+/5 for right hip abduction. Left hip strength is 3+/5.

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KEY FEATURES

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Description
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  • Softening of bone mass and density with a marked decrease in cortical thickness and cancellous bone trabeculae, leading to increased fragility, deformity, and/or fracture

  • Osteomalacia is due to a lack or an inability to process of vitamin D

  • Metabolic bone disease

  • Inadequate or delayed mineralization of osteoid in mature cortical and spongy bone1

  • Has normal amount of collagen

  • Fracture with minimal injury

  • Rickets in children affects mineralization of the growth plates

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FIGURE 134-1

X-ray of the pelvis of an elderly woman with osteomalacia. Note marked bowing of both femoral necks, with pseudofractures of the medial aspect of the femoral necks and the superior aspect of the left pubic ramus (arrows). (From McPhee SJ, Papadakis MA. Current Medical Diagnosis and Treatment 2011. 50th edition. New York, NY: McGraw-Hill. Photograph courtesy of Dr. Harry Genant.)

Graphic Jump Location
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Essentials of Diagnosis
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  • Bone mineral density (BMD) measurements are related to both peak bone mass and bone loss.

  • Decreased serum calcium levels

    • Low levels of serum 25-hydroxyvitamin D

  • Bone Densitometry: Normal BMD within 1 SD of the mean, T-score at -1.0 and greater.

  • Bone Densitometry: Low BMD (referred to as osteopenia) occurs between 1 and 2.5 SD below the mean, T-score between -1.0 and -2.5.

  • Increased fracture propensity is due to demineralization secondary to osteoporosis that often occurs at the spine, hips, pelvis, or wrist.

  • Accurate patient and family medical histories and early recognition through physical examination may lead to improved therapeutic outcomes.

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