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Osteomalacia/Rickets
Softening of bones due to vitamin D deficiency (rickets=children; osteomalacia=adults
Pathophysiology
Decreased Vitamin D → decreased calcium and phosphate absorption → inadequate mineralization of bone matrix
Signs and Symptoms
Bone pain and muscle weakness
waddling gate
Bowed legs (children)
Pathologic fractures
Fatigue
Risk Factors
Inadequate sun exposure
Malabsorption (e.g., celiac, CKD)
Poor nutrition
Anticonvulsant therapy
Liver or Kidney disease
Diagnostics
Decreased Vitamin D, decreased calcium, decreased phosphate
Increased ALP (Alkaline Phosphatase)
X-ray: Looser’s zones (pseudofractures)
Bone Biopsy (rare)
Nursing Management
Increase sunlight exposure
Nutritional Counseling (calcium, Vitamin D)
Prevent falls
Gentle Physical Activity
Pharmacologic Treatment
Vitamin D3 (cholecalciferol): Corrects deficiency
Calcium Supplements: Supports bone hardness
Phosphate Supplements (if low)
Calcitriol (active Vitamin D): Especially in renal failure
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)