OSTEOMALACIA Definition • • • AKA • Also called rickets in infants and young children; osteomalacia in adults Vitamin D deficiency that

doesn’t allow bone to calcify normally Prognosis good with treatment Possible disappreance of bone deformities in children

Incidences • Rare in the United States • Does appear occasionally in breast-fed infants who don’t receive a vitamin D supplement or in infants fed a formula with a nonfortified milk base • Occurs in overcrowded, urban areas where smog limits sunlight penetration • Incidence of rickets is highest in children with darkly pigmented skin who, because of their pigmentation, absorb less sunlight. Risk/Precipitating factors • Inadequate dietary intake of vitamin D • Malabsorption of vitamin D • Inadequate exposure to sunlight • Inherited impairment of renal tubular reabsorption of phosphate (from vitamin D insensitivity) in vitamin D-resistant rickets (refractory rickets, familial hypophosphatemia) • Conditions reducing the absorption of fat-soluble vitamin D • Hepatic or renal disease • Malfunctioning parathyroid gland contributing to calcium deficiency and interfering with vitamin D activation in the kidneys Manifestation • 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

coating the trabeculae and linings of the haversian canals and areas beneath the periosteum. The formation of callouses in the affected area is also common. falling serum calcium concentration stimulates synthesis and secretion of parathyroid hormone. • When bone matrix mineralization is delayed or inadequate. This gives the appearance of a false fracture. • This causes large quantities of ostoid to accumulate.5 mg/dl • Serum inorganic phosphorus concentration less than 3 mg/dl • Serum citrate level less than 2. Diagnostic studies Laboratory • Serum calcium concentration less than 7. bone is didorganized in structure and lacks density. ostid may be produced but mineralization can’t proceed normally. • Structure A band of bone material of decreased density may form alongside the surface of the bone.5mg/dl • Alkaline phosphatase level less than 4 Bodansky units/dl 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) Pseudofracture • is a diagnostic form of osteomalacia. The result is gross deformity of both spongy and compact bone.• • • • • • • Pigeon breast (protruding ribs and sternum) Delayed closing of fontanels Softening skull Bulging forehead Poorly developed muscles (pot belly) Difficulty walking and climbing stairs Kyphoscoliosis Pathophysiology • Vitamin D regulates the absorption of calcium ions from the intestine. • This causes the release of calcium from bone. decreasing renal calcium excretion and increasing renal phosphate excretion. Thickening of the periosteum occurs. Typical sites of involvement are the axillary . • When the concentration of phosphate in the bone decreases. • When vitamin D is lacking.

provide consultation with appropriate specialist. proximal ends of the femora and ulna. 1. 25-hydroxycholecalciferol.25dihydroxycholecalciferol. ribs. nephrolithiasis. is client education. biochemical. Disturbed body image related to trauma Risk for powerlessness related to deformed bones through body Nursing Responsibility Much of the orthopaedic nurse’s role in assessing and treating osteomalacia is collaborative. Management Medication • Massive oral doses of vitamin D or cold liver oil • For rickets refractory to vitamin D. psychiatrist) . The goal in treating osteomalacia is to normalize the clinical. these deficiencies need to be resolved. hypercalciuria. dietitian. or ectopic calcification. or in rickets accompanied by hepatic or renal disease. or a synthetic-analogue of active vitamin D Surgery • Possible surgical intervention for intestinal disease • Appropriate repair of bone fractures Nursing Diagnosis • • • • • Impaired Physical Mobility related to bone decalcification and bone deformities and possible fractures High Risk for Injury related to weak bones due to demineralization Acute Pain related to skeletal deformities and muscular stretching or strain or impingement of nerves. The primary nursing responsibility. Client education is useful in resolving such insufficiencies as well as educating the health care community and families at risk. In more complex Client teaching and nursing management for the client with osteomalacia • teach client about modes of treatment and prognosis • teach client about high-vitamin. hyperphosphatemia. low-fat diet • Instruct client in importance of maintaining adequate nutritional balance. and radiologic abnormalities without producing hypercalcemia. as indicated (e.g. If the cause of osteomalacia is related to a simple dietary deficiency of calcium or vitamin D. pubic rami.margins of the scapula. after assessment of causative factors. high-protein.

as necessary Teach client about high fracture risk. poorly ossified epiphyseal centers . Illustration Rickets of the knees demonstrates bowing of the femurs. related to fragile bone status Teach client to space activities and move slowly Review limitations in ADLs and promote ongoing independence in ADLs within scope of limitations Review safety and fall precaution. even with minor trauma. coarsening of the trabecular pattern.• • • • • • • • Teach client how to use ambulatory devices. discuss gradual resumption of selected activities Recommend extra precautions in walking dog in neighborhood and possibly walking on flat surfaces. with physical therapist’s assistance. as evaluated by serial bone mineral density scans. and provide current literature about occurrence of falls and how to create a safe home environment Recommended reduction of daily alcohol intake As treatment progress. metaphyseal cupping and fraying. increase in distance between end of shaft and epiphyseal center.

Susan W. Maher. Salmond and Teresa A.References • • • Nurse’s Quick Check Disease 2005 (Marguerile Ambrose) Orthopaedic Nursing (Leona Mourad) Orthopaedic Nuring third edition (Ann B. Pellino) .

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