Osteomalacia treatment - Vitamin D deficiency

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Successful treatment of osteomalacia is accomplished by mineralization of the soft bones matrix with light, dietary advice and supplements of vitamin D and calcium.

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Sunlight (ultraviolet B light) in the treatment of osteomalacia (soft bones)

The sunlight apart from containing visible light composes a broad band of invisible light and ultraviolet (UV) light is one of them.

Ultraviolet light is again divided into three types depending upon the wave length like UV-A, UV-B and UV-C.

The UV-A spectrum causes sun tan and sunburn. Long exposure to UV-C can cause skin cancer. UV-B is involved in the production of vitamin D in the skin and strengthening the soft bones.

The presence of UV-B is relative to the slant of the light. Greater the slant lesser are the UV-B rays present.

Exposure between 10am-2pm gives the maximum benefit of vitamin D synthesis and helps in osteomalacia treatment.

In places like north America, Canada, northern Europe, northern Asia and southern Australia the slant of the sunlight is greater especially in their winter.

People who are confined to homes or have indoor jobs and those with darker skin are very high risk groups in these areas and may become deficient in vitamin D and develop osteomalacia resulting in soft bones.

They should make every possible attempt to go out in the sun to prevent osteomalacia.

The exposure of face, arms and hands to 15-20 minutes of sunlight is sufficient to produce required vitamin D in fair skinned people and will help in prevention of osteomalacia.

For people with darker skin require more exposure as the dark pigment melanin in their skin filters the sunlight.

Light-therapy (phototherapy) for osteomalacia 

The light treatment is given using lamps which give light near equal to sunlight for a specific period. Special bulbs and lamps are available in the market.

Alternatively UV-B radiating devices are also available with the sole purpose of vitamin D production in the skin.

Please take medical advice before using them in osteomalacia care due to the side-effects of the over-exposure.

Nutrition in osteomalacia

Food rich in cholecalciferol like fortified milk and cereals, egg, canned tuna and sardines, herring, mackerel and salmon are given during recuberation. Cod and its liver oil and liver are good sources of vitamin D. However it is doubtful whether adequacy levels of the nutrient can be reached through food sources only.

Vitamin D (cholecalciferol) supplements for Osteomalacia

Depending upon the condition, osteomalacia treatment includes oral or intra-muscular supplements of cholecalciferol and calcium. Phosphorus supplements may also be given.

During this period, supplements of cholecalciferol of strength 800-4000 IU/per day are given for 6 - 8 weeks.

Serum levels of calcium rises within 48 hours of the start of the treatment with cholecalciferol.

There will be marked improvement of the condition of the osteomalacia affected within a few days of starting of the treatment for soft bones (osteomalacia).

After 8 weeks the cholecalciferol dose may be reduced to the normal maintenance level of 400 IU/day and the condition of osteomalacia resolves.

If there is any absorption problem in osteomalacia affected, intra-muscular injections are given and excess vitamin D is stored by the body for future utilization. Sufficient calcium should be given during treatment.

During treatment regular blood tests may be done to keep track of the cholecalciferol in serum. Cholecalciferol in excess can cause hypercalcaemia, a condition in which the presence of excess calcium in the blood causing problems.

For the treatment of osteomalacia, efforts must be taken to prevent it by sufficient exposure of the body to sunlight and the inclusion of vitamin D rich food in our daily diet.

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Osteomalacia diagnosis - Soft bones

Home > Diagnosis of osteomalacia - Soft bones

The diagnosis of osteomalacia (soft bones) is by visual observations, laboratory tests, radiography and biopsy.

Diagnosis of osteomalacia (soft bones) by visual observation

Osteomalacia starts as pain in the lower back and thighs and spreads to legs, arms and ribs.

The affected person appears weak and has difficulty even in walking.

He may have waddling gait. He may have 'swayback' appearance.

He may complain of pain all over the body and especially in limbs. The pain increases in shocks and on pressure.

He has pain in the back, hips and the long limbs. He complains of muscle weakness.

He may have fractures without any fall or known reason.

Young adults may show slight bowing of long limbs.

The patient may have tetany, spasms, numbness in the limbs and abnormal heart beats.

All these observed signs help in the differentiating osteomalacia from other conditions.

Laboratory procedures

The serum calcium is lower than the required level (hypocalcemia).

Phosphorus serum levels will be low (hypophosphatemia).

Serum alkaline phosphate and PTH (parathyroid hormone) will be elevated than the normal level.

Serum levels of 25-hydroxyvitamin D will be low.

Urine calcium will be low.

Urine 1,25-dihydroxyvitamin D levels will be low.

Radiography procedures for osteomalacia bones

Radiography of the affected skeletal areas show deformity.

Partial fractures are seen on the soft bones.

Radiographs of the affected limbs show pseudofractures of bones (Loser's zones or Milkman syndrome).

Protrusio acetabuli (the socket protruding into pelvis) condition may appear restricting the movement of hip joint.

In diagnosis, radiography further shows osteopenia of bones wherein the mineral density is lower than the normal.

Vertebral compression fractures may be present.

Biopsy for diagnosis of osteomalacia

Biopsy of the soft bones shows increased osteoid and lowered calcifying mineral.

Once the ailment shows up as osteomalacia in the diagnosis, the patient is given required treatments to bring him back to normalcy.

Related topics:
Osteomalacia (soft bones).
Causes.
Symptoms
Treatment.
Prevention.
Rickets in children.

Current topic:
Soft bones and diagnosis of osteomalacia.

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Osteomalacia symptoms - Soft bones

Home > Osteomalacia signs and symptoms

Common signs and symptoms of osteomalacia are bone pain, muscle pain and easy fractures of bones in the adults.

Osteomalacia affected patient shows signs and symptoms like widespread pain in the bones

The signs of osteomalacia may not be confused with arthritis pain which is the inflammation of the joints and the resultant pain.

The signs and symptoms are specific. Osteomalacia caused pain emanates from the skeletal tissue. This pain is of permanent character deep and nagging.

The pain emanates from back, hips, ribs and long bones. Pain is also caused by minor cracks (partial fractures).

Osteomalacia affected person shows signs and symptoms of weak muscles

With the pain in the bones the patients mobility decreases and the patient may also show signs of myalgia (muscle pain).

Low levels of calcium and phosphorus along with low levels of vitamin D affect muscle functions.

With reduced activity the muscle mass may decrease and muscle atrophy may set in. There can be partial or complete wasting away of the muscles.

Muscle weakness especially of the upper arms and thighs, decreases the quality of life and the sufferer experiences great difficulty in performing simple tasks like getting up from a chair or climbing a flight of stairs.

Osteomalacia affected person shows symptoms like fractures on trivial causes

Pathologic fractures may occur in osteomalacia affected person. The fractures occur during the normal routine activities.

The reason for this is that the bones have so badly demineralised that they are not able to perform normal routine functions.

Deformity in osteomalacia

The affected person may suffer from lordosis a deformed condition of the vertebrae.

There is curvature of the vertebral column in lower back giving 'swayback' appearance to the person. Deformities of the pelvis may also occur.

The gait of the patient is affected and he shows typical signs of waddling gait (myopathic gait).

The waddling is due to deformity of the pelvic girdle and also due to proximal muscles getting weak.

The osteomalacia patient sometimes may experience tetany. Uncontrolled muscle spasm and seizures are due to low serum levels of calcium.

Related topics:
Osteomalacia.
Causes.
Diagnosis.
Treatment.
Prevention.
Rickets in children.

Current topic:
Symptoms of osteomalacia - Soft bones.

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Osteomalacia causes - soft bones - adults - vitamin D deficiency

Home › Osteomalacia › Nutritional deficiency › Rickets in children › Soft bones

Among many factors, severe vitamin D deficiency causes osteomalacia resulting in soft bones by their hypomineralisation in adults.

Adult skeletal structures after attaining growth, due to many factors connected with vitamin D deficiency, lose the calcium and phosphorus in them during bones turnover and become soft. The causes of osteomalacia are numerous.

Insufficient exposure to sunlight is one of the prime causes of osteomalacia (soft bones)

People living in higher latitudes face shorter days, especially in winter. They are also compelled to be home bound due to adverse weather conditions and soft bones result. In darker skinned people the soft bones problem is compounded due to their reduced vitamin D synthesis ability. This is due to high melanin pigment deposits in their skin which cut off UV-B rays from reaching the vitamin D producing region of the skin and causes vitamin D deficiency and osteomalacia (soft bones).

Deficiency of vitamin D in diet is one of the causes of osteomalacia

The plant sources of vitamin D are very limited. Animal fats especially fish oils and fats are rich in vitamin D. Eggs and animal liver also contains vitamin D. Fortified milk and fortified cereal flours also can be good sources. Vegans who do not even drink milk are in the risk of getting osteomalacia and soft bones. Economically weaker sections of the people are prone to get affected by both calcium and vitamin D deficiency. This causes osteomalacia and soft bones.

Living in places continuously affected by fog and smog causes osteomalacia

Residents of the cities continuously covered by fog and smog may be affected or get into presymptomatic stage of this ailment and soft bones.

Medicine used in the treatment of epilepsy and seizures causes osteomalacia

Epileptics may suffer from soft bones. Epileptic seizures are prevented and controlled by phenobarbital and phenytoin. These drugs increase the hepatic metabolism. By this reaction the vitamin D is converted into inactive forms and the calcium absorption is affected leading to soft bones.

Orlistat (weight-loss drug) and cholestyramine (cholesterol-lowering drug) reduce absorption of fat soluble vitamins like vitamin D. Corticosteroids like prednisone may decrease calcium absorption and causes osteomalacia (soft bones) by affecting cholecalciferol metabolism.

Malnutrition during pregnancy causes osteomalacia

Pregnant women transfer lots of vitamin D, calcium and phosphorus to the growing fetus. The vitamin D and calcium reserves in the pregnant woman's body are tapped to maintain uninterrupted supply to the growing fetus. If the supplies are not replenished by diet, supplements and sunlight exposure deficiency results and causes osteomalacia and soft bones.

Celiac disease causes osteomalacia

Celiac disease (coeliac disease) is a disorder of the small intestine which is autoimmune in nature with genetic predisposition. In this disease there is a reaction of the body to gluten protein present in wheat. There is inflammation of the small intestine and atrophy of the villi which are responsible for nutrient absorption.

Hence there no nutrient absorption and along with many deficiency induced ailments, severe deficiency of vitamin D also occurs and causes osteomalacia and soft bones. Certain types of cancers, hereditary disorders in the metabolism , renal diseases like renal tubular acidosis and disease of the liver can be the causes of osteomalacia and soft bones.

Osteomalacia prevention- Soft bones - - Vitamin D

Home > Osteomalacia prevention -Vitamin D - Soft bones

Prevention of osteomalacia (soft bones) is by exposure to sufficient sunlight (ultraviolet B light), exposure to UV-B lamps, dietary intake of balanced foods and use of supplements of vitamin D, calcium and phosphorus.

Prevention of osteomalacia in pregnant women and nursing mothers

Pregnant women are among the high risk group for osteomalacia.

During pregnancy there is increased fetal demand of vitamin D and calcium.

As the pregnancy progresses there is greater demand of calcium for the growth of soft bones of fetus. Pregnant women if they continue with their normal diet during their late pregnancy their calcium and vitamin D reserves get depleted and osteomalacia occurs.

To protect from osteomalacia, pregnant women should have sufficient exposure of sunlight, eat food high in vitamin D and take calcium and calcitriol supplements.

Lactating mothers lose calcium and vitamin D through the milk.

Hence nursing mothers are also prone to deficiency disease of osteomalacia in them is by following the prevention methods as in the case of pregnant women.

Prevention of osteomalacia in vegans and vegetarians

Vegans and vegetarians may be eating calcium sources of vegetarian food.

However for the absorption of calcium in the gut they must have sufficient calcitriol (vitamin D).

If they are deficient, they may also develop osteomalacia.

The prevention is by resorting to exposure to sunlight, balanced food and supplements.

Prevention of soft bones in adults living in higher latitudes

People living in higher latitudes are highly prone to develop osteomalacia as the incidence of sunlight is at a greater angle in higher latitudes, especially in winter.

The slant of sunlight greatly reduces the availability of the UV-B rays required for calcitriol production in the skin.

In winter the available time of the sunlight itself is reduced.

For the prevention of osteomalacia they must take dietary supplements of vitamin D and UV-B light exposure under medical guidance.

Soft bones in dark skinned adults

The darker color of the skin is due the presence of melanosomes (bundles of melanin pigment). Greater number of melanosomes contribute to darker skin. The melanin deposits function as sunlight filters.

In dark skin very less amount of UV-B rays reach the synthesis areas compared to lighter skin for the same time of exposure leading to deficiency and soft bones.

For protection deficiency and soft bones the dark skinned people should get more exposure to sunlight and if necessary take dietary supplements.

Prevention of osteomalacia (soft bones) in elderly persons, persons affected by gastrointestinal disorders, renal disorders and certain types of cancers is a vast subject by itself.

These are the very high risk adults groups for soft bones and constant monitoring of their blood serum levels for calcium is necessary for preventing of osteomalacia, apart from constant efforts to shore up their calcium and vitamin D levels.

Related posts:
Osteomalacia.
Causes.
Symptoms.
Diagnosis.
Treatment.
Rickets in children.

Current topic:
Vitamin D for prevention of osteomalacia and soft bones.

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Osteomalacia - vitamin D deficiency - adults

Home > Osteomalacia - Vitamin D deficiency in adults

Osteomalacia is a condition in adults where in the bones get softened due to deficiency of vitamin D or the inability of body to absorb/utilise cholecalciferol.

The essential problem in this metabolic disease of adults is the non-availability of phosphorus and/or calcium for mineralisation of freshly formed osteoid usually in adults.

This disease in children is called rickets. The basic cause of this mineral insufficiency is the deficiency of vitamin D (cholecalciferol).

Unlike the severity of the symptoms in children this insufficiency in adults shows signs like body pains, muscle pains and soft fragile bony structures.

Osteomalacia is hypomineralization of the osteoid after the cessation of its growth.

In contrast, in rickets, hypomineralization of the growing bones takes place affecting growth plates.

Normal mineralisation depends on many interdependent factors, which supply sufficient phosphorus and calcium to the skeletal tissues.

By its action on the gastrointestinal tract, parathyroid glands, kidneys and the bones, vitamin D maintains a balance of calcium and phosphorus.

Hydroxylation of cholecalciferol is necessary for the maintenance of the above balance. Hydroxylation takes place in liver and kidneys.

Osteomalacia occurs when any of the above metabolic processes dysfunctions and soft bones result.

Though both osteomalacia and osteoporosis result in soft and fragile bones in adults the processes of the making of this condition are very different.

In osteoporosis, porosity of the skeletal tissue results due to faster breaking down of them than their reformation.

However in osteomalacia though the two activities are balanced, the bones which are formed do not get mineralised to become hard and dense.

There are a number of causes for the occurrence of osteomalacia, the most important being the deficiency of cholecalciferol in adults.

The signs of osteomalacia are general weakness, myalgia, lack of appetite, loss of weight and fragile and soft bones.

This malady of deficiency is diagnosed with blood tests, biopsy and radiography.

Osteomalacia is treated by giving large doses of vitamin D to replenish it in adults.

Related topics:
Causes of the ailment in adults.
Osteomalacia symptoms.
Diagnosis.
Treatment.
Prevention of vitamin deficiency in adults.
Rickets in children.

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