Osteomalacia
Prevalence
Asia, africa, middle east
Pediatric considerations
Bone development, genetic component, called rickets in children
Treatments
Braces or surgery for bone deformities. Osteotomy may be performed to correct long bone deformity
Medication treatments
Calcitiol (vitamin) (vitamin D3) fat soluble Calcium salts
Patho
Deficiency of activated vitamin D, which promotes calcium absorption for gi tract and facilitates mineralization from tract
Geriatric considerations
Diet adequate intake of calcium and vitamin D, sun exposure, increased risk of bone fracture, long term maintenance therapy, comorbidities
How often should you draw labs during treatment with calcitol
Draw serum calcium and phosphate twice a week for two weeks Calcium, magnesium, alkaline phasphatase, and intact PTH should be assessed monthly
Signs and symptoms
Dull, aching pain in lower back, pelvis, and hips (wt bearing), worse at night, decreased muscle tone, bones fracture easily, spinal kyphosis, bowed legs, skeletal deformities, waddle walk, and increased risk for falls
Complications
Fall risk, pathological fractures, difficult walking, and unusual physical appearance
Population affected
Homebound elderly
Causes
Kidney and liver disorders: lack of vitamin D because the kidney and liver convert vitamin D to active form Drugs celiac disease phasphate depletion due to poor nutrition decreased sunlight exposure
Define osteomalacia
Metabolic bone disease, softening of the bones, inadequate mineralization of bones, marked by severe vitamin D deficiency
Nursing interventions
Pain management, psychological health, fall risk, long term monitoring
Nursing assessment
Pain, strength, balance, gait
Patient education
Prevention DIET DIET DIET and sunlight
Diagnostic tests
X-ray, labs (serum calcium, phosphorus, ALP) bone biopsy **usually xray and blood tests are enough to diagnose
Assessment during medication therapy
bone pain and weakness
Prognosis
depends on underlying cause, generally very good. if pt isn't resistant to tx, complete healing within 6 months
Side effects of calcitiol
dizziness, malaise Life threatening: pancreatitis
Bone biopsy results
increased amount of osteoid (demineralized cartilaginous bone matrix)
Lab findings
low vitamin d, calcium, and phosphorus, elevated ALP. Low caclium and creatinine in the urine
