11. Bone Disorders: Osteomalacia/Rickets

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8 Terms

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Osteomalacia/Rickets

Softening of bones due to vitamin D deficiency (rickets=children; osteomalacia=adults

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Pathophysiology

Decreased Vitamin D → decreased calcium and phosphate absorption → inadequate mineralization of bone matrix

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Signs and Symptoms

  • Bone pain and muscle weakness

  • waddling gate

  • Bowed legs (children)

  • Pathologic fractures

  • Fatigue

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Risk Factors

  • Inadequate sun exposure

  • Malabsorption (e.g., celiac, CKD)

  • Poor nutrition

  • Anticonvulsant therapy

  • Liver or Kidney disease

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Diagnostics

  • Decreased Vitamin D, decreased calcium, decreased phosphate

  • Increased ALP (Alkaline Phosphatase)

  • X-ray: Looser’s zones (pseudofractures)

  • Bone Biopsy (rare)

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Nursing Management

  • Increase sunlight exposure

  • Nutritional Counseling (calcium, Vitamin D)

  • Prevent falls

  • Gentle Physical Activity

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Pharmacologic Treatment

  • Vitamin D3 (cholecalciferol): Corrects deficiency

  • Calcium Supplements: Supports bone hardness

  • Phosphate Supplements (if low)

  • Calcitriol (active Vitamin D): Especially in renal failure

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Surgical Intervention

🦴 Corrective Osteotomy

  • Indication: Severe bone deformities (e.g., bowed legs) in rickets not responsive to vitamin D/calcium

  • Purpose: Cuts and realigns bones to correct deformities

  • Post-op: Immobilization, monitor for proper healing, continue nutritional therapy (vit D & Ca)