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