Osteomalacia

“Delayed Mineralization”

Metabolic disease characterized by inadequate and

delayed mineralization of osteoid in mature

compact and spongy bone.

Osteomalacia

Osteoblasts brings out new bone by their synthesis of osteoid.

Osteoid bone are non-mineralized bone matrix.

Osteoid

Bone Remodeling Cycle Phase 1 (activation)

a stimulus activates the bone cells precursors in the localized area of the bone to form osteoclasts.

Phase 2. (resorption)

osteoclast forms a “cutting cone” which gradually resorb bone, leaving behind and elongated cavity.

Phase 3 (formation)

laying down of new bone by osteoblast lining the walls of the resorptive cavity.

Bone Remodeling Cycle

Bone Formation

Phase 3 Mineralization

Initiation (Formation) Proliferation (Accretion)

Phase 1 Production of organic

matrixPhase 2 Calcification

Also known as

RICKETS

in infant or growing children

Risks Factor

Risk Factor

Inadequate exposure to sunlight

Risk Factor

Parathyroid gland dysfunction

Risk Factor

Risk Factor •Drugs such as

phenytoin, phenobarbital– Interfere with

calcium absorption and increase in degradation of vitamin D metabolism in the liver.

•Drugs such as phenytoin, phenobarbital– Interfere with

calcium absorption and increase in degradation of vitamin D metabolism in the liver.

Osteomalacia Patho

↑ PTH secretion

INTESTINES ↑ calcium absorption

KIDNEYS ↑ phosphate excretion

(phosphaturia)

Imbalance calcium and phosphate

concentration

Decrease bone crystallization

Osteomalacia

Decrease Calcium

Risks factor

Vitamin D deficiency

Osteomalacia

Knock knees

Bowed legs

asymptomatic until a fracture occurs

Progressive deformities of bones of extremities

and spine

Fractures

Enlarged wrists and ankles

-Kyphoscoliosis

Persistent skeletal pain

Progressive muscle weakness

Rachitic rosary Pigeon chest

Delayed closing of fontanels

Softening skull

- Fractures of bones - Persistent skeletal pain - Progressive deformities of bones of extremities and spine - Progressive muscle weakness - May be asymptomatic until a fracture occurs - Leg and lower back pain due to vertebral collapse - Bowed legs- Knock knees - Rachitic rosary (beading of ends of ribs)

-Enlarged wrists and ankles - Pigeon chest (protruding ribs and sternum) - Delayed closing of fontanels - Softening skull - Bulging forehead - Difficulty walking and climbing stairs -Kyphoscoliosis

Manifestation

Bone Fracture

GENU VALGUM or KNOCK KNEES

RACHITIC ROSARY

PECTUS CARINATUM or PIGEON CHEST

KYPHOSCOLIOSIS

1. Acute Pain r/t stimulation of free nerve endings 2 to muscular stretching or impingement of nerves. 2. Impaired Physical Mobility r/t bone decalcification and bone deformities. 3. High Risk for Injury r/t softening of bones 2 to delayed mineralization 4. Disturbed body image r/t bowing of legs.

Nursing Diagnosis

Laboratory

-Serum calcium concentration less than 7.5 mg/dl - Serum inorganic phosphorus concentration less than 2 mg/dl - Serum citrate level less than 2.5mg/dl - Alkaline phosphatase level less than 4 King Armstrong units/dL

-PTH : < 10 picograms/ml NV 10-55 picograms per milliliter (pg/mL).

Diagnostic studies

IMAGING

X-rays showing characteristics bone deformities and abnormalities such as Looser’s transformation zones (radiolucent bands perpendicular to the surface of the bones indicating reduced bone ossification confirm the diagnosis)

Diagnostic studies