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  • 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


  • 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


  • 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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