Osteomalacia and rickets
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OSTEOMALACIA & RICKETS
Abdullah
Taskeen
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DIFINATION :
Rickets :
osteopenia with disordered calcification leading to higher proportion of osteoid (unmineralized) tissue prior to epiphyseal closure (in childhood)
osteomalacia :
osteopenia with disordered calcification leading to higher proportion of osteoid (unmineralized) tissue after epiphyseal closure (in adulthood)
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BASIC:
Bone consists of :
A- a hard outer shell (cortex) made up of minerals, mainly calcium and phosphorus,
B- a softer inner mesh (matrix) made up of collagen fibres.
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WHEN NORMAL BONE IS FORMED :
A - these fibres are coated by mineral (this process is called mineralisation).
B - The strength of the new bone depends on enough mineral covering the collagen matrix.
The more mineral laid down, the stronger the bone.
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OSTEOMALACIA HAPPENS : A. if mineralisation doesn’t take place properly.
B. bone is made up of collagen matrix without a mineral covering,
C. so the bones become soft.
D. These softened bones may bend and crack, and this can be very painful.
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AGAIN !! DIFINATION :
Rickets :
osteopenia with disordered calcification leading to higher proportion of osteoid (unmineralized) tissue prior to epiphyseal closure (in childhood)
osteomalacia :
osteopenia with disordered calcification leading to higher proportion of osteoid (unmineralized) tissue after epiphyseal closure (in adulthood)
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ETIOLOGY AND PATHOPHYSIOLOGY
A. Vitamin D Deficiency
B. Mineralization Defect
C. Phosphate Deficiency
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CLINICAL PRESENTATION :
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INVESTIGATION :
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OTHERS :
Serum 25OHD = low ( exept in V. D resistance rickets )
Serum fibroblast FGF-23 = elevated in tumor associated osteomalcia
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RADIOLOGIC FINDINGS - pseudofractures,
‘Looser’s zones’
- Linear areas of low density surrounded by sclerotic
borders.
- loss of radiologic distinctness of vertebral bod trabecula,
- concavity of the vertebral bodies
- narrow radiolucent lines (healed stress fractures )
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Looser Zones
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Looser Zones
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diffuse osteopenia and several insufficiency stress fractures of the bilateral ribs (arrows) and scapulae
Stress fracture
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several insufficiency stress fractures in the right femoral lesser trochanter, both femoral necks (arrows), acetabula (arrowhead), and pubic rami (white arrow).
Stress fracture
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GOLD STANDARD Bone biopsy :
A. Increased osteoid width (> 15 μm),
B. increased mineralization lag time, and
C. lack of Uptake of double tetracycline labelling in osteoid seams.
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ostoid ( pink ) > 80 % Ostoid thickness > 12 um
Mineralization lag time > 100 days
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RX: - depends on the underlying cause
• vitamin D supplementation • PO4 supplements if low serum PO4 is present
• Ca supplements for isolated calcium deficiency
• bicarbonate if chronic acidosis
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RX :
calcitriol or alfacalcidol
there is defective 1α-hydroxylation,
e.g. chronic kidney disease, vitamin D dependency and hypophosphataemic rickets with osteomalacia.
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REFERENCES :
Kummar & clarck 7th edition
MD- consult
Good bye !!