RICKETS AND OSTEOMALACIA

NUR FADZLINA BINTI ZABRI 082013100006

RICKETS
DEFINITION :

Disease in young children due to vitamin D deficiency which results in bone deformities. Disease may set in about 6th month of life Characterized by :
Soft bone deficient deposition of Ca salts

Bones easily bent under the weight of body

Vitamin D deficiency

Poor absorption Ca+

Proteins of new bone fails to mineralize

Rickets

Pathology
Process of ossification at the epiphyseal line takes place in an abnormal manner Older cartilage cells degeneration does not occur. Ossification is retarded Serum Ca+ and serum PO4 levels decrease

Tetany may occur as complication

Serum alkaline phosphatase raised

Characteristics features

Thickening of wrists and ankles

Delayed dentition

Rickety rosary

Deformed bones

Widening and cupping of epiphyseal growth plate

 Inadequate exposure of sun Malabsorptio n

Chronic kidney failure Vitamin D-resistant rickets type I

Vitamin D deficienc y Failure of 1,25 vitamin D synthesis

CAUS ES
Others

Genetic defects

Liver failure Fluoride

Vitamin D receptor defects Hypophosphatemi c

OSTEOMALACIA- Adult rickets

Amount of mineral accretion in bone per unit of

bone matrix is deficient in adults Due to deficiency of Vitamin D and inadequate absorption of Ca+ Limited to females :

After multiple pregnancies Lactation

Characterized by :
Bone pain and tenderness Soft bones

Fractures may occur Proximal myopathy

Causes
vitamin D deficiency

Renal tubular acidosis

Malnutrition during pregnancy Malabsorption syndrome ; Coeliac disease Hypophosphatemia Chronic renal failure Tumor-induced osteomalacia

Diagnosis
Blood tests:
Serum calcium : low serum phosphorus : low serum alkaline phosphatase: high

Radionucleid bone scan X-ray Bone biopsy is rarely performed but will confirm

rickets.

Treatment
Diet and lifestyle Cod liver oil Exposing the skin to the sunlight Ca+ supplements Ergocalciferol -250-1000g daily Surgery remove severe bone abnormalities ( bowlegs or spinal deformities)

References
Textbook of Physiology Volume I, 3rd Edition.

Written by Prof. A. K. Jain. Published by Avichal Publishing Company. DAVIDSONS PRINCIPLES AND PRACTICE OF MEDICINE 21st EDITION

http://www.medicinenet.com/rickets/

http://www.mayoclinic.org/diseases-

conditions/rickets/91