Osteomalacia

Subject: Medical and Surgical Nursing I (Theory)

Overview

Osteomalacia is the softening of the bones as a result of defective bone metabolism, generally as a result of insufficient amounts of phosphate, calcium, and vitamin D in the blood, or as a result of calcium absorption. Inadequate bone remineralization results from impaired bone metabolism. Children's osteomalacia is referred to as rickets. Despite having many different root causes, adult osteomalacia is eventually brought on by a vitamin D shortage. Other factors include chronic renal failure, hypophosphatemia, malabsorption syndrome, and undernutrition during pregnancy. It can be identified through serology, bone biopsy, x-rays, etc. It may be treated with a significant oral vitamin D dose. Inform the client of the high fracture risk associated with fragile bone status, which occurs even with minor trauma, and suggest cutting back on daily alcohol consumption.

Osteomalacia

Osteomalacia is the softening of the bones brought on by impaired bone metabolism, primarily as a result of insufficient levels of calcium, phosphate, and vitamin D, or possibly calcium resorption. Inadequate bone remineralization results from impaired bone metabolism. Due to the fact that osteomalacia in children is also known as rickets, the term "osteomalacia" is frequently only used to refer to the less severe form of the condition in adults.

Fatigue, generalized body aches, muscle weakness, and bone fragility are some of the signs and symptoms.

Pathophysiology

The intestinal absorption of calcium ions is controlled by vitamin D. Falling blood calcium levels in vitamin D deficiency promote parathyroid hormone production and release. Due to the release of calcium from the bone, the kidneys excrete less phosphate. Ostid may form when the phosphate content of the bone decreases, yet regular mineralization cannot take place. Large amounts of ostid build up as a result, coating the trabeculae, lining the Haversian canals, and regions below the periosteum. Bone is disorganized structurally and lacks density when bone matrix mineralization is postponed or insufficient. Gross deformity of both spongy and compact bone is the end result.

Causes

The causes of adult osteomalacia are varied, but ultimately result in a vitamin D deficiency:

  • Insufficient nutritional quantities or faulty metabolism of vitamin D or phosphorus.
  • Renal tubular acidosis.
  • Malnutrition during pregnancy.
  • Malabsorption syndrome.
  • Hypophosphatemia.
  • Chronic kidney failure.
  • Tumor-induced osteomalacia.
  • Long-term anticonvulsant therapy.
  • Celiac disease.
  • Cadmium poisoning, Itai-Itai disease.

Sign and Symptoms

  • Diffuse joint and bone pain (especially of spine, pelvis, and legs).
  • Muscle weakness.
  • Difficulty walking, often with waddling gait.
  • Hypocalcemia (positive Chvostek sign).
  • Compressed vertebrae and diminished stature.
  • Pelvic flattening.
  • Weak, soft bones.
  • Easy fracturing.
  • Bending of bones.

Diagnosis Studies

Laboratory

  • Serum calcium concentration less than 7.5mg/dl.
  • Serum inorganic phosphate concentration less than 3mg/dl.
  • Serum citrates less than 2.5mg/dl
  • X-rays and other imaging tests can show small cracks in the bones throughout your body. These cracks are called Looser’s transformation zones. Fractures can begin there with even small injuries.
  • A bone biopsy may be required to definitively diagnose osteomalacia. A needle is inserted through your skin and muscle and into your bone to obtain a small sample

Treatment

  • The massive oral dose of vitamin D.
  • For rickets refractory to vitamin D, or in rickets accompanied by hepatic or renal disease, 25- hydroxycholecalciferol, 25- dihydroxycholecalciferol, or a synthetic analog of active vitamin D.
  • Possible surgical intervention for intestinal disease.
  • Appropriate repair of a bone fracture.

Nursing Management

  • Teach client about a mode of treatment and prognosis.
  • Teach client about high vitamin, high protein, low-fat diet.
  • Instruct client in importance in maintaining adequate nutritional balance, provide consultation with an appropriate specialist, as indicated.
  • Teach client how to use ambulatory devices, with physical therapist assistance as necessary.
  • Teach client to space activities and move slowly.
  • Review limitation in ADLs and promote ongoing independence in ADLs within a scope of limitation.
  • Teach client about the high fracture risk, even with minor trauma, related to fragile bone status.
  • Review safety and fall precaution and provide current literature about an occurrence of falls and how to create the safe environment.
  • Recommended reduction of daily alcohol intake.

 References

  • books.google.com/books?isbn=0781789400

  • books.google.com/books?isbn=1605477664

  • findzebra.com/?q=ipex&&f=osteomalacia

  • https://ja.scribd.com/doc/17647437/osteomalacia

  • healthline.com › Reference Library

  • Mandal, G. (August 2013). A Textbook of Adult Health Nursing (2nd ed.). Dilllibazar kathmandu: Makalu publication house. Retrieved August 2013

  • quizlet.com/21766893/osteomalacia-flash-cards/

  • quizlet.com/12713796/med-surg-ii-2-musculoskeletal-problems-flash-cards/

  • revolvy.com/main/index.php?s=Odontoblast

  • thevisualmd.com/searchimg/?idu=1033608284&q=vitamin&p=13
  • wikipediaaudio.com/Mollities_ossium
  • www.coursehero.com › ITT Tech › NU › NU 2530
Things to remember
  • The softening of the bones is known as osteomalacia.
  • Due to the fact that osteomalacia in children is also known as rickets, the word "osteomalacia" is frequently only used to refer to the less severe form of the condition in adults.
  • The intestinal absorption of calcium ions is controlled by vitamin D.
  • Despite having many different root causes, adult osteomalacia is eventually brought on by a vitamin D shortage.
  • painful bones and joints all throughout (especially of spine, pelvis, and legs)
  • walking difficulty, frequently with a waddling stride
  • Osteomalacia may need to be definitively diagnosed with a bone biopsy.
  • Inform the client about a high-protein, low-fat, and vitamin-rich diet.
  • Diffuse body aches, muscle weakness, and bone fragility are just a few signs and symptoms that may appear.
Questions and Answers

Osteomalacia

Osteomalacia is the softening of the bones as a result of impaired bone metabolism, primarily as a result of insufficient levels of phosphate, calcium, and vitamin D in the blood, or as a result of calcium absorption. Inadequate bone remineralization results from impaired bone metabolism. Since rickets is the name for osteomalacia in children, the term "osteomalacia" is frequently only used to refer to the disease's milder adult form.

Causes

The causes of adult osteomalacia are varied, but ultimately result in a vitamin D deficiency:

  • Inadequate nutrient intake or improper phosphorus- or vitamin-D-metabolism,
  • Acidosis of the renal tubules,
  • Being undernourished when pregnant,
  • Metabolic syndrome,
  • Hypophosphatemia,
  • Persistent renal failure,
  • Cancer-related osteomalacia,
  • Treatment with long-term anticonvulsants,
  • Celiac illness,
  • Ingestion of cadmium and Itai-Itai sickness.

Sign and Symptoms

  • Diffuse joint and bone pain (especially of spine, pelvis, and legs),
  • Muscle weakness,
  • Difficulty walking, often with waddling gait,
  • Hypocalcemia (positive Chvostek sign),
  • Compressed vertebrae and diminished stature,
  • Pelvic flattening,
  • Weak, soft bones,
  • Easy fracturing,
  • Bending of bones.

Treatment

  • The massive oral dose of vitamin D.
  • For rickets refractory to vitamin D, or in rickets accompanied by hepatic or renal disease, 25- hydroxycholecalciferol, 25- dihydroxycholecalciferol, or a synthetic analog of active vitamin D.
  • Possible surgical intervention for intestinal disease.
  • Appropriate repair of a bone fracture.

Nursing Management

  • Teach client about a mode of treatment and prognosis.
  • Teach client about high vitamin, high protein, low-fat diet.
  • Instruct client in importance in maintaining adequate nutritional balance, provide consultation with an appropriate specialist, as indicated.
  • Teach client how to use ambulatory devices, with physical therapist assistance as necessary.
  • Teach client to space activities and move slowly.
  • Review limitation in ADLs and promote ongoing independence in ADLs within a scope of limitation.
  • Teach client about the high fracture risk, even with minor trauma, related to fragile bone status.
  • Review safety and fall precaution and provide current literature about an occurrence of falls and how to create the safe environment.
  • Recommended reduction of daily alcohol intake.

 

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