Osteomalacia can be described as a bone condition which affects the mineralization of bone. It is often caused by disorders pertaining to vitamin D and phosphate metabolism. It causes a softening of the bones due to the reduced uptake of calcium necessary to maintain a normal bone density.(2, 3)
In many countries Vit D deficiencies are on the rise. People who are most at risk of acquiring this condition are the homebound elderly who have poor Vit D intake in their diets and have minimal exposure to the sun. Also people who have undergone gastric bypass surgery often have malabsorption problems as do those suffering from celiac disease this inhibits the absorption of ingested Vit D and the ability to uptake calcium thus making these people more at risk of acquiring osteomalacia.(4)
Signs & Symptoms
- Bone Pain
- Muscular weakness
- Unbalanced diet
- Discomfort during physical activity
- Can present radiologically as osteopenia
- Pathologic fractures from little or no trauma
- Little or no exposure to sunlight
- Post menopausal women
Lab Tests
- Vitamin D (Expect Low)
- Alkaline Phosphatase (Expect Increase)
- Calcium & Phosphate (Expect Low)
- Bone densitometry
- Bone X-ray
- Bone Biopsy
Review of Evidence for Management
When treating Osteomalacia it is important to understand what the underlying cause of the disease is ruling in or out any red flag conditions that may be a primary cause of the Osteomalacia e.g. renal or hepatic diseases.
When treating Osteomalacia as the primary condition, it is recommended that the patient receives increased exposure to the sunlight and is given an oral dose (50,000 IU) of Vitamin D2 1-2 times per week until osteomalacic mutations have healed (usually 6 months). If there is an underlying malabsorption disease 1.5g of elemental calcium is administered as well as an oral daily dose of Vitamin D2 (50,000 IU).
If this proves to be ineffective intramuscular doses of Vit D2 (10,000 IU) can be given daily until the Osteomalacia has resolved then a upkeep dose orally of (800-1000iu) is sufficient to prevent the disease from returning.(5)
Sources
- Alan Rose G. The radiological diagnosis of osteoporosis, osteomalacia and hyperparathyroidism. Clinical Radiology.15(1):75-83.
- Gifre L, Peris P, Monegal A, Martinez de Osaba MJ, Alvarez L, Guañabens N. Osteomalacia revisited : a report on 28 cases. Clinical Rheumatology. 2011;30(5):639-45.
- MedlinePlus. Osteomalacia. Available from:https://www.nlm.nih.gov/medlineplus/ency/article/000376.htm.
- Menkes C. Epidemiology and etiology of osteomalacia 2013. Available from:https://www.uptodate.com/contents/epidemiology-and-etiology-of-osteomalacia.
- Arya V, Jain V. Osteomalacia—what the rheumatologist needs to know. Indian Journal of Rheumatology. 2007;2(1):17-22. osteopath
