Osteomalacia
In adults, vitamin D deficiency results in Osteomalacia which is characterised by a wide scam of unmineralised matrix (osteoid) living the bone surfaces. Vitamin resistant rickets is an inherited disorder which is apparently caused by defective receptors for 1,25(OH)2 D3
The common presenting features are pain and mascular weakness.Pain ranges from a dull ache to severe pain.Sites frequently affected are ribs,sacrum,lower lumber vertebrae,pelvis and legs.Bone tenderness on pressure is common. Mascular weakness is often present and the patient may find difficulty in climbing stairs or getting out of a chair.A waddling gait is not unusual.
There is rarefaction of bone and commonly translucent bands(pseudo fractures, Looser's zones) often symmetrical at points submitted to compression stress. Common sites are the ribs,the axillary borders of the scapula, the public rami and the medical cortex of the upper femur.Looser's zones are diagnostic of Osteomalacia.
Diagnosis :
Radiograph of the wrist may show characteristic changes at the epiphyses.The outline of the joint is blurred and hazy and the epiphyseal line becomes broadened. Later in older children, as a result of decalcification of the metaphysis and the effects of movements and stresses the classical concave 'saucer' deformity is clearly shown radiographically.The diagnosis is supported by a raised plasma alkaline phosphatase and confirmed if plasma 25(OH)D is low.
Treatment :
A daily oral dose of 25-125 μg (1000-500IU) of vitamin D cures osteomalacia. Because of the risk of toxicity this should be reduced to 10 μg,the prophylactic dose,when plasma alkaline phosphatase has returned to normal and radiographs show that healing is established. Children can be given 1 ml of halibut oil.
Advice on diet and general hygiene is needed.An adequate intake of calcium is essential. The best source is milk and at least 500 ml should be taken daily. An egg daily and butter or fortified margarine to increase the dietary intake of vitamin D are recommended.Children should enjoy playing in the sun.
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Nutrition Science by B. Srilakshmi
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