Republic of the Philippine

ISABELA STATE UNIVERSITY

Echague, Isabela

COLLEGE OF NURSING
PHILIPPINE ORTHOPEDIC CENTER

OSTEOMALACIA

- Osteomalacia is a metabolic bone disease characterized by inadequate mineralization

of bone. As a result of faulty mineralization, there is softening and weakening of the
skeleton, causing pain, tenderness to touch, bowing of the bones, and pathologic
fractures
- In children, the condition is called rickets.
CLINICAL MANIFESTATIONS

- Weakness in muscles and bones

- Bone pain
- Softening of the bone
- Fractures (Pseudofractures)
DIAGNOSTICS

- X-RAY: On x-ray studies, generalized demineralization of bone is evident. Studies of the

vertebrae may show a compression fracture with indistinct vertebral endplates. Presence of
pseudo fractures or looser’s transformation zone is a good evident that osteomalacia is
present. Looser’s transformations are radiolucent areas of bones that results from multiple
microstress fractures that heal by the formation of osteomalacic bone, which is not
mineralized.
Figure 1: (a) Looser zones of
osteomalacia in a case of tumour-
induced osteomalacia in both pubic
rami demonstrating broad bands of
lucency, marginal sclerosis and
absence of callus; (b) Looser zones of
osteomalacia in a case of renal tubular
acidosis located on medial shaft of left
femur demonstrating two oblique
lines; (c) atypical insufficiency fracture
simulating Looser zone of
osteomalacia due to osteoporosis
demonstrating a broad band of
lucency with marginal sclerosis in the
neck of femur; (d) atypical insufficiency
fractures due to osteoporosis
simulating Looser zone of
osteomalacia and AFFs demonstrating
broad bands of lucency with marginal
sclerosis on the medial shaft of the
femur. ((c) and (d), reproduced with
permission from Elsevier). 
- Bone Biopsy: The diagnosis of osteomalacia can be confirmed by an iliac crest bone biopsy.
Histological correlate is reduced or deficient mineralization of the newly synthesized
extracellular matrix.
- Blood Test: levels of calcium, phosphorus and vitamin D are measured.
 Republic of the Philippine
ISABELA STATE UNIVERSITY
Echague, Isabela

COLLEGE OF NURSING
PHILIPPINE ORTHOPEDIC CENTER

Alkaline phosphatase, which is a substance made by the cells that make bone. This is at a
raised level in people who have osteomalacia.
Parathyroid hormone, produced by the parathyroid gland, is raised as part of the body’s
reaction to low vitamin D levels.

ANATOMY & PHYSIOLOGY

 Republic of the Philippine
ISABELA STATE UNIVERSITY
Echague, Isabela

COLLEGE OF NURSING
PHILIPPINE ORTHOPEDIC CENTER

PATHOPHYSIOLOGY

MODIFIABLE FACTORS NON-MODIFIABLE

-People who live in four FACTORS
season country -Lactose intolerant people
- Decreased exposure to -Women
sunlight -Elderly
- Malnutrition -People w/ dark skin
OSTEOMALACIA

DEFICIENCY OF
ACTIVATED VITAMIN D
(CALCITONIN)

REDUCED INTESTINAL
ABSORPTION OF
CALCIUM AND
EXCESSIVE LOSS OF Ca
FROM THE BODY

LOW SERUM CALCIUM &

PHOSPHATE

DEMINERALISATION OF
BONE (CALCIUM &
RESORPTION)

SOFTENING AND
WEAKENING OF THE
BONES
MUSCLE AND BONE
PAIN

MEDICAL MANAGEMENT:
 Republic of the Philippine
ISABELA STATE UNIVERSITY
Echague, Isabela

COLLEGE OF NURSING
PHILIPPINE ORTHOPEDIC CENTER

-Treat underlying cause if possible

-Sunlight
-Mineral supplements (calcium/vitamin D)
Note: Avoid overdose and monitor serum calcium)
-Gentle handling to relief pain

SURGICAL MANAGEMENT
-osteotomy
-sequestrectomy

NURSING MANAGEMENT
 Teach the importance of maintaining an adequate intake of milk and other dairy
products that are not only rich in calcium and phosphorus, but also are fortified
with vitamin D.
 Teach patients to use assistive devices such as walkers, canes, or crutches when
ambulating. Teach about safety measures to prevent falls.
 Encourage patients to participate in a supervised exercise program such as water
aerobics or tai chi.
 Foods to avoid is gluten ex. Wheat barley can damage lining of small intestine

REFERENCE:
https://www.researchgate.net/figure/a-Looser-zones-of-osteomalacia-in-a-case-of-
tumour-induced-osteomalacia-in-both-pubic_fig2_257535494

Reuss-Borst MA. Metabolische Knochenkrankheit Osteomalazie [Metabolic bone

disease osteomalacia]. Z Rheumatol. 2014 May;73(4):316-22. German. doi:
10.1007/s00393-013-1285-8. PMID: 24811356.
https://pubmed.ncbi.nlm.nih.gov/24811356/#:~:text=Alkaline%20phosphatase
%20(AP)%20is%20typically,the%20newly%20synthesized%20extracellular
%20matrix.
https://www.versusarthritis.org/about-arthritis/conditions/osteomalacia/