Osteomalacia

• Rickets (specific to occurrence children)

• 268.2 Osteomalacia unspecified

• M83.9 Adult osteomalacia, unspecified

• 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

Description

• 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

Essentials of Diagnosis

• 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

General Considerations

• 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

Demographics

• Children (rickets)
• Elderly
• Individuals with absorption issues in the intestines

Signs and Symptoms

• 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

Functional Implications

• 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 fracture2,3

• Vitamin D deficiency
• Age (>/= 50 years)
• Gender (female>male)
• Kidney failure
• Liver disease
• Limited sun exposure
• Overuse of suntan lotion with no sun exposure
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