pathology: osteomalacia

yogabook / pathologie / osteomalacia

Osteomalacia („adult rickets“)

Definition of

Increased softness and tendency to bend due to increased breakdown of minerals from the bone matrix. Pathomechanism: pure decalcification

ICD M83

Cause

mainly: Vitamin D or calcium deficiency. Its causes are:

  1. Malassimilation due to liver disease with reduced production of bile and therefore reduced fat emulsion
  2. Pancreatic diseases with reduced production of lipase (maldigestion)
  3. Crohn’s disease (malabsorption)
  4. The provitamin D is absorbed and activated in the skin by UV light to form D1. Just 10 minutes of daylight (it does not have to be sunlight) per day on the hands and face is sufficient for this. It is then hydroxylated in the liver and hydroxylated again in the kidneys and is only then available as active vitamin D = 1-25-DiHydroxyCholeCalziferol. This is the only way it can be absorbed or reabsorbed from the intestine or the proximal tubule of the kidney. To compensate for the deficiency, the body increases parathyroid hormone, the increased production takes on a life of its own and leads to hyper-PTH (the increase is reversible with a clear time lag)
  5. Kidney diseases with phosphaturia lead to osteomalacia due to insufficient apatite formation, too little phosphate
  6. Medication: Antiepileptic drugs

Diagnosis

Laboratory:

  1. Blood: AP,Ca elevated
  2. Urine: Ca in urine

Symptoms

  1. Skeletal pain, diffusely distributed; dull, persistent joint and muscle pain (altered static conditions)
  2. Highlight: Compression pain (pressing from above in a jerky manner on bones that are not normally painful, such as the shoulder area, sternum or tibia, causes pain)
  3. Highlight: Bone deformities, for example in the form of knock knees or bow legs
  4. Highlight: Waddle walk
  5. Skeletal muscle weakness
  6. Constipation
  7. Adynamia (muscular)
  8. Tendency to stomach ulcers

Complications

  1. Kidney stones (Ca-oxalate)
  2. Increased tendency to fracture, especially femoral neck

Therapy

  1. Vitamin D, calcium and calcium supplements
  2. Sun
  3. Cod liver oil
  4. If osteoporosis is present (especially in older people), treat this as well