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Condition/Disorder Synonym

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  • Rickets (specific to occurrence children)

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ICD-9-CM Code

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  • 268.2 Osteomalacia unspecified

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ICD-10-CM Code

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  • M83.9 Adult osteomalacia, unspecified

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Preferred Practice Patterns1

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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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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

  • Due to a lack or an inability to process of vitamin D

  • Metabolic bone disease

  • Normal amount of collagen

  • Fracture with minimal injury

  • Rickets in children affects mineralization of the growth plates

  • Inadequate or delayed mineralization in mature cortical and spongy bone

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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 standard deviation (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 SDs below the mean; T-score between -1.0 and -2.5

  • Increased fracture propensity is due to demineralization secondary to osteoporosis; 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

  • 10-year risk for fracture can be measured through Fracture Risk Assessments (FRAX® score)

  • Pharmacotherapy can be measured through changes in laboratory values

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General Considerations

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  • Widespread bone pain

  • Persons with low BMD are at an increased risk for the development of osteoporosis; prevention is critical to reduce incidence

  • According to the National Osteoporosis Foundation (NOF), over 10 million Americans have osteoporosis and another 34 million have low BMD and therefore at increased risks for the development of osteoporosis

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Demographics

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  • Children (rickets)

  • Elderly

  • Individuals with absorption issues in the intestines

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Clinical Findings

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Signs and Symptoms

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  • Known clinically as a ‘silent' disease; can be asymptomatic until fracture occurs

  • Vertebral fractures may present as severe back pain or with no pain or sensation noted

  • Muscle weakness

  • Hypocalcemia

  • Bone pain (common in the hips)

  • Deformations of the vertebral spine and loss of height may present clinically as kyphosis or lordosis

  • Spasms in the hands and feet

  • Heart arrhythmia

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Functional Implications

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  • Causes disability for aging and elderly women and men

  • Approximately 20% of women and 30–50% of men with hip fractures secondary to osteoporosis die within 1 year of sustained fracture...

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