OSTEOMALACIA

OSTEOMALACIA – Etiology, Signs and Symptoms, Pathophysiology, Diagnostic Evaluation and Management

Osteomalacia refers as a metabolic disease of bones, often caused by a vitamin D deficiency. Metabolic disorder characterized by inadequate or delayed mineralization of bone and it result from a defect in the bone-building process

ETIOLOGY

Body uses calcium and phosphate to build strong bones. Osteomalacia may occur if bodies do not get enough of these minerals in diet or if body does not absorb them properly. These problems may be caused by:

• Vitamin D deficiency: people who live in areas where sunlight hours are short or eat a diet low in vitamin D can develop osteomalacia. Vitamin D deficiency is a common cause of osteomalacia
• Certain surgeries: normally, the stomach breaks down food to release vitamin D and other minerals that are absorbed in the intestine. This process is disrupted if one has surgery like gastrectomy and may result in osteomalacia. Surgery to remove or bypass small intestine also can lead to osteomalacia
• Celiac disease: in this autoimmune disorder, the lining of small intestine is damaged by consuming foods containing gluten, a protein found in wheat, barley and rye. A damaged intestinal lining does not absorb nutrients, such as vitamin D, as well as a healthy one does
• Kidney or liver disorders: problems with kidneys or liver can interfere with ability to process vitamin D
• Drugs: drugs used to treat seizures, including phenytoin and Phenobarbital, can cause osteomalacia

SIGNS AND SYMPTOMS

• Bone pain
• Tenderness
• Difficulty in changing position
• Muscle weakness
• Bowing of bones
• Pathologic fractures

PATHOPHYSIOLOGY

Due to any cause —- decreased level of vitamin D —- decreased absorption of calcium and phosphorus from intestine —- serum level of calcium and phosphorus decreases —- activate parathyroid gland —- result in less of calcium and phosphorus from bones —- deformity of bones —- bone became soft and unable to bear stress and weight

DIAGNOSTIC EVALUATION

• Physical examination: check for skeletal deformity like spinal kyphosis, bowed legs
• Blood and urine tests: in cases of osteomalacia caused by vitamin D deficiency or by phosphorus loss, abnormal levels of vitamin D and the minerals calcium and phosphorus are often detected
• X-ray: slight cracks in bones that is visible on X-rays
• Bone biops: during a bone biopsy, doctor inserts a slender needle through skin and into bone to withdraw a small piece of bone for viewing under a microscope. This procedure is done after using a local anesthetic and takes only about a half-hour. Although a bone biopsy is very accurate in detecting osteomalacia

MANAGEMENT

• Vitamin D, phosphorus, calcium supplements are prescribed
• Exposure to sunlight is also advised to patient (for short period of time)
• Vitamin D rich diet (fortified milk and milk products, cereals, egg, etc) is given to the patient

NURSING MANAGEMENT

Nursing Diagnosis

1. Impaired physical mobility related to decalcification and stretching of the muscles

Interventions

• Encourage patient to do the daily activities
• If person is not able to perform daily routine then assist him
• Ask patient for some exercises but also ready with some pain control measures
• Provide supplements of calcium as prescribed by the physician

• Bone pain related to weakness and stretching of muscles

Interventions

• Assess the intensity, duration, onset of the pain
• Assess the measures use by the health care time previously
• Provide comfort devices
• Provide medications as prescribed by the physician
• Provide psychological support and assist while changing the position

• Risk for fractures related to calcium deficiency and muscle weakness

Interventions

• Assess for any cracks on the bones
• Encourage for vitamin D rich diet
• Provide calcium supplements to the patient as prescribed by physician