1. Osteomalacia
Adult rickets

2. Word Meaning
Greek origin
Osteo – bone
Malacia - softness

3. Definition
Osteomalacia is defined as a Rare bone disorder associated with vitamin D deficiency, resulting in decalcification and softening of bone.

4. Incidence
Women mostly affected (Muslims)
Its endemic in Asia

5. Etiology Lack of exposure to UV rays (needed for Vit.D synthesis)
Drugs – anticonvulsants (phenytoin)
GI malabsorption
Extensive burns
Chronic diarrhoea
Pregnancy – multiple pregnancy
Kidney disease

6. Excessive loss of calcium (celiac disease, biliary tract obstruction, chronic pancreatitis)
After surgery of gastrointestinal system

7. Pathophysiology Vit.D insufficiency
Vit.D required for the absorption of the calcium from the intestine
Insufficient vit.D intake can interfere with the normal mineralization of bone activity or insufficient calcification of bone
Leads to bone softening and associated symptoms

8. Clinical features Bone become bent and flattened as they soften
Pathologic fracture
Fatigue, malaise, bone pain (with tenderness)
Difficult to walk, rise from a chair, low back pain, progressive muscle weakness, weight loss , deformity of spine (kyphosis), fracture with delayed healing

10. Diagnostic investigation
X-ray – generalized demineralization with trabecular bone loss
Bone biopsy
Serum calcium and phosphorus levels are reduced
Alkaline phosphates level is moderately elevated

11. Management Diet – vit D, calcium and phosphorous rich
Vit.D3 (cholecalciferol), vit.D2 (ergocalciferol)
Calcium salts and phosphorous supplements may also prescribed
Eggs, low fat milk, fish
Exposure to sunlight
Weight bearing exercises
Orthopedic deformities may be treated with surgery (osteotomy).

12. Nursing management Assessment
Assess for bone pain in the low back and extremities
Assess for fracture
Obtain information about co existing diseases (malabsorption syndrome) and dietary habits
Note skeletal deformities on physical examination

13. Relieving pain – change in positions and analgesic
Improving body image – trusting relationship, encourage patient to discuss any changes in body image and methods of coping
Encourage to use existing strength
Allow talk with the similar successful patients

14. Nsg diagnosis Acute pain r/d to bone tenderness and possible fracture
Disturbed body image related to bowing of legs, waddling gait and spinal deformities
Deficient knowledge about disease process and treatment

15. Pagets disease (osteitis deformans)

16. Def - idiopathic Skeletal bone disorder in which there is excessive bone resorption followed by replacement of altered bone tissue
The new bone is larger, disorganized and structurally weaker
Common sites – pelvis , long bones, spine, ribs, sternum and cranium

17. Etiology Exact cause is unknown
Followed by viral infection (measles virus, respiratory syncytial virus )
Genetic (15%-30%)
Men to women ratio – 2:1
Seen in below 40 years

18. Pathophysiology Due to unknown causes Increase BONE RESORPTION
Altered BONE TURN OVER
As a compensatory mechanism - increase bone formation
Newly formed bones are large, unorganized and weak
Structural changes in weight bearing limbs and other manifestation

19. Signs and symptoms Free of symptoms in the early stages
Bone pain – deep ache – progress to severe pain
Fatigue
Progressive development of waddling gait
Become shorter
Barrel chest

20. Bowing of tibia or femur
Changes in skin temperature
Manifestations related to nerve compression

21. Increase bone volume in the spine can cause spinal cord or cranial root compression leads to head ache, blindness, vertigo, hearing loss with tinnitus and dementia
Pathologic fracture , osteosarcoma, fibrosacroma and osteoclastoma tumors are complications
Osteoarthritis are common associated with pagets disease

22. Diagnostic investigation
X rays – shows increased bone expansion and density.
Bone scan
Serum alkaline phosphates levels increased
N-telopeptide and C-telopeptide they are biomarkers used to measure the rate of bone turnover, can be measure from urine or serum

23. Management Limited to symptoms Supportive care
Correction of secondary deformity
Calcitonin – decrease osteoclastic activity

24. Bisphosphonate drugs –
Risedronate, Tidronate, Pamidronate, Ibandronate – retard bone resorption
Calcium and vitamin D supplements
Pain – NSAIDS, ibuprofen.
Orthopedic surgeries for fracture, hip and knee replacements
Firm mattress – back support and to relieve pain
Wear light brace
Activity like lifting and twisting should be avoided

25. Prevention Physical therapy will increase muscle strength
Good body mechanics
Balanced nutrition programme – vit.D, calcium and protein
Massage, heat therapy
Prevention
Patient education
Use of an assistive device