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| {{Infobox medical condition
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| | Name = Osteomalacia (rickets)
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| | Image =
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| | Caption =
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| |Field = [[Endocrinology]]
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| | DiseasesDB = 9351
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| | ICD10 = {{ICD10|M|83||m|80}}
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| | ICD9 = {{ICD9|268.2}}
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| | ICDO =
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| | OMIM =
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| | MedlinePlus = 000376
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| | eMedicineSubj = ped
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| | eMedicineTopic = 2014
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| | eMedicine_mult = {{eMedicine2|radio|610}}
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| | MeshName =
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| | MeshNumber =
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| | MeshID = D010018
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| }}
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| '''Osteomalacia''' is the softening of the [[bone]]s caused by deactivated [[bone mineralization]] primarily due to inadequate levels of available [[phosphate]] and [[calcium]], or because of [[bone resorption|resorption]] of calcium. Osteomalacia in children is known as [[rickets]], and because of this, use of the term "osteomalacia" is often restricted to the milder, adult form of the disease. Signs and symptoms can include diffuse body pains, muscle weakness, and fragility of the bones.
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| The most common cause of osteomalacia is a deficiency of [[vitamin D]], which is normally derived from sunlight exposure and, to a lesser extent, from the diet.<ref>[https://www.nlm.nih.gov/medlineplus/ency/article/000376.htm MedlinePlus Medical Encyclopedia: Osteomalacia<!-- Bot generated title -->]</ref> The most specific screening test for [[vitamin D deficiency]] in otherwise healthy individuals is a serum 25(OH)D level.<ref>{{cite book|last1=Longo|first1=Dan L.|title=Harrison's principles of internal medicine.|date=2012|publisher=McGraw-Hill|location=New York|isbn=978-0-07174889-6|edition=18th|display-authors=etal}}</ref> Less common causes of osteomalacia can include hereditary deficiencies of vitamin D or phosphate (which would typically be identified in childhood) or malignancy.
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| Measures to prevent and treat osteomalacia usually revolve around intake of vitamin D and [[calcium|calcium supplements]]. Vitamin D should always be administered in conjunction with calcium supplementation since most of the consequences of vitamin D deficiency are a result of impaired mineral ion homeostasis.<ref>{{cite book|last1=Longo|first1=Dan L.|title=Harrison's principles of internal medicine.|date=2012|publisher=McGraw-Hill|location=New York|isbn=978-0-07174889-6|edition=18th|display-authors=etal}}</ref>
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| Nursing home residents and the homebound elderly population are at particular risk for vitamin D deficiency, as these populations typically receive little sun exposure. In addition, both the efficiency of vitamin D synthesis in the skin and the absorption of vitamin D from the intestine decline with age, thus further increasing the risk in these populations. Other groups at risk include individuals with malabsorption secondary to gastrointestinal bypass surgery or celiac disease, and individuals who immigrate from warm climates to cold climates, especially women who wear traditional veils or dresses that prevent sun exposure.<ref>{{cite journal|last1=Kennel|first1=KA|last2=Drake|first2=MT|last3=Hurley|first3=DL|title=Vitamin D deficiency in adults: when to test and how to treat.|journal=Mayo Clinic Proceedings|date=August 2010|volume=85|issue=8|pages=752-7; quiz 757-8|pmid=20675513|doi=10.4065/mcp.2010.0138}}</ref>
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| ==Signs and symptoms==
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| Osteomalacia is a generalized bone condition in which there is inadequate mineralization of the bone. Many of the effects of the disease overlap with the more common [[osteoporosis]], but the two diseases are significantly different.
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| There are two main causes of osteomalacia: (1) insufficient calcium absorption from the intestine because of lack of dietary calcium or a deficiency of, or resistance to, the action of vitamin D; and (2) phosphate deficiency caused by increased renal losses.
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| *Diffuse joint and [[bone pain]] (especially of spine, pelvis, and legs)
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| *Muscle weakness
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| *Difficulty walking, often with waddling gait
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| *[[Hypocalcemia]] (positive [[Chvostek sign]])
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| *Compressed vertebrae and diminished stature
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| *Pelvic flattening
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| *Weak, soft bones
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| *Easy fracturing
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| *Bending of bones
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| Osteomalacia in adults starts insidiously as aches and pains in the [[lumbar]] (lower back) region and thighs before spreading to the arms and ribs. The pain is symmetrical, non-radiating and accompanied by sensitivity in the involved bones. Proximal muscles are weak, and there is difficulty in climbing up stairs and getting up from a [[squatting position]].
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| As a result of demineralization, the bones become less rigid. Physical signs include deformities like triradiate pelvis<ref>{{cite journal |last1=Chakravorty |first1=N. K. |title=Triradiate deformity of the pelvis in Paget's disease of bone. |journal=Postgraduate Medical Journal |volume=56 |issue=653 |pages=213–5 |year=1980 |pmid=7393817 |pmc=2425842 |doi=10.1136/pgmj.56.653.213}}</ref> and [[lordosis]]. The patient has a typical "waddling" gait. However, these physical signs may derive from a previous osteomalacial state, since bones do not regain their original shape after they become deformed.
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| Pathologic fractures due to weight bearing may develop. Most of the time, the only alleged symptom is [[fatigue (medical)#Chronic fatigue|chronic fatigue]], while bone aches are not spontaneous but only revealed by pressure or shocks.
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| It differs from renal [[osteodystrophy]], where the latter shows [[hyperphosphatemia]].
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| ==Causes==
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| The causes of adult osteomalacia are varied, but ultimately result in a vitamin D deficiency:
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| *Insufficient nutritional quantities or faulty metabolism of [[vitamin D]] or [[phosphorus]]
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| *[[Renal tubular acidosis]]
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| *[[Malnutrition]] during [[pregnancy]]
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| *[[Malabsorption]] syndrome
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| *[[Hypophosphatemia]]<ref>{{cite web|url=http://mpkb.org/home/pathogenesis/vitamind|title=Autoimmunity research foundation, Science behind Vitamin D|accessdate=2011-07-19}}</ref>
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| *[[Chronic kidney failure]]
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| *[[Tumor-induced osteomalacia]]
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| *Long-term [[anticonvulsant]] therapy<ref>{{cite journal |last1=Pack |first1=Alison |title=Bone health in people with epilepsy: is it impaired and what are the risk factors |journal=Seizure |volume=17 |issue=2 |pages=181–6 |year=2008 |pmid=18187347 |doi=10.1016/j.seizure.2007.11.020}}</ref>
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| *[[Celiac disease]]<ref>{{cite journal |last1=Albany |first1=Costantine |last2=Servetnyk |first2=Zhanna |title=Disabling osteomalacia and myopathy as the only presenting features of celiac disease: a case report |journal=Cases Journal |volume=2 |issue=1 |pages=20 |year=2009 |pmid=19128487 |pmc=2626577 |doi=10.1186/1757-1626-2-20}}</ref>
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| *[[Cadmium poisoning]], [[Itai-itai disease]]
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| ==Diagnosis==
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| ===Biochemical findings===
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| Biochemical features are similar to those of [[rickets]]. The major factor is an abnormally low vitamin D concentration in blood serum.
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| Major typical biochemical findings include:<ref>{{cite journal|last1=Holick|first1=Michael F.|title=Vitamin D Deficiency|journal=New England Journal of Medicine|date=19 July 2007|volume=357|issue=3|pages=266–281|doi=10.1056/NEJMra070553|pmid=17634462}}</ref>
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| *Low serum and urinary calcium
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| *Low serum phosphate, except in cases of [[renal osteodystrophy]]
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| *Elevated serum [[alkaline phosphatase]] (due to an increase in compensatory [[osteoblast]] activity)
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| *Elevated [[parathyroid hormone]] (due to low calcium)
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| Furthermore, a [[technetium]] bone scan will show increased activity (also due to increased osteoblasts).
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| {{Bone pathology}}
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| ===Radiographic characteristics===
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| Radiological appearances include:
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| *[[Pseudofracture]]s, also called Looser's zones.
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| *[[Protrusio acetabuli]], a hip joint disorder
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| ==Treatment==
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| Nutritional osteomalacia responds well to administration of 10,000 [[International Unit|IU]] weekly of vitamin D for four to six weeks. Osteomalacia due to malabsorption may require treatment by injection or daily oral dosing<ref>{{cite journal |last1=Eisman |first1=John A. |title=6 Osteomalacia |journal=Baillière's Clinical Endocrinology and Metabolism |volume=2 |pages=125–55 |year=1988 |doi=10.1016/S0950-351X(88)80011-9}}</ref> of significant amounts of vitamin D.
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| ==Etymology==
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| Osteomalacia is derived from Greek: ''osteo-'' which means "bone", and ''malacia'' which means "softness". In the past, the disease was also known as '''malacosteon''' and its Latin-derived equivalent, '''mollities ossium'''.
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| Osteomalacia is associated with increase in osteoid maturation time.
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| ==References==
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| {{reflist}}
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| ==See also==
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| *[[Osteopetrosis]], the opposite of osteomalacia
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| {{Nutritional pathology}}
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| {{Osteochondropathy}}
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| [[Category:Pediatrics]]
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| [[Category:Osteopathies]]
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| [[Category:Vitamin D]]
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