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Osteomalacia and rickets (vit D deficiency) (Aetiology (Neoplastic …
Osteomalacia
and rickets
(vit D deficiency)
Management
Conservative
Information and advice
Lifestyle (balanced diet with dairy, oily fish,
reducing risk factors)
Monitoring (Ca, vit D)
Medical
Vit D replacement
Indication: dietary insufficiency, renal disease, liver disease
E.g. Ca vit-D3 PO; if hepatic disease, Vit-D2 (ergocalciferol);
if renal disease/resistance, 1OH-D (alfacalcidol)
Definition
Osteomalacia
Failed mineralisation
of mature bone (uncalcified)
Rickets
Failed mineralisation of
growing bone/osteoid
Epidemiology
Rickets in children
Osteomalacia in adults
Pathophysiology
Low vit D intake
Low oral feed, malabsorption
Low sunlight exposure
Abnormal vit D metabolism
Renal/liver disease, reducing vit D metabolism
Drugs affecting vit D metabolism (e.g. enzyme inducers)
Genetic vit D resistance
Low phosphate
Low intake
Aetiology
Neoplastic
Oncogenichypophosphatemia
Idiopathic
Inadequate sunlight
Metabolic
Low intake vit D
Malabsorption of vit D (Coeliac, Crohns, CF)
Renal disease
Liver disease
Congenital
X-linked vit D resistance
Fanconi syndrome (renal loss phos)
Drugs
Inducers e.g. AEDs
Risk factors
Dark skin
Little sun
Age (young, elderly)
Epilepsy
CLD, CKD
Clinical
presentation
Rickets
Failure to thrive
Bow legs
Widened wrists/ankles
(metaphyseal expanision)
Delayed fontanelle closure
Hypotonia
Seizures
Malaise
Osteomalacia
Malaise
Bony pain
Proximal myopathy
Fractures
Diagnosis
Examination
Musculoskeletal
Frontal skull bossing, palpable fontanelles,
bow legs, widened wrists/ankles,
rickets rosary (palpable chostochondrial joints)
Harrisons sulcus on chest,
Neurological
Hypotonia, seizures
Investigations
Bedside
Obs
ECG
Bloods
FBC, U+E, LFT, bone profile (high ALP, low/norm Ca,
low/norm phos, high PTH), vit D (low, unless vit D resistance)
Imaging
X-ray legs: bowed
X-ray wrists: widened ragged metaphyses,
widened epiphyseal plate)
CXR: cardiomegaly
History
DH
Meds, allergies
FH
Malabsorption, kidney/liver disease
PMH
Growth and development
Known medical conditions
SH
Living arrnagements, occupation/school/nursery,
smoking, alcohol, social services
PC/HPC
Failure to thrive, short stature,
bowed legs, widened ankles/wrists, malaise,
fractures, bony pains
Diet, feeding, bowels
Complications
Heart failure
Stunted growth
Seizures
Misery
Prognosis
Healing within 2-4 wk,
resolution of bony deformities can take years