Week 4: Osteomalacia

what is osteomalacia

low bone density from defective mineralization of bone ( called this in adults when epiphyses are fused)

osteomalacia is a deficiency in what 3 things that cause defective mineralization

calcium, phosphorus, low alkaline phosphatase

rickets

defective bone mineralization in childhood before epiphyseal fusion

osteomalacia 4 causes

insufficient intestinal calcium absorption (vit d), calcium/phosphate deficiency, kidney disease, adverse drug reactions

risk factors of osteomalacia (general)

old, cold location, vit D deficiency, gastrectomy, intestinal malabsorption

what is considered as intestinal malabsorption

disease of SI, cholangiolitic disorders of liver, biliary obstruction, chronic pancreatic insufficiency

increased risk of osteomalacia if on what meds long term?

anticonvulsants, barbiturates, antacids, lithium, etidronate

increased risk of osteomalacia if history of what?

hyperparathyroidism, chronic renal failure, renal tubular defects (decreased absorption of phosphate)

signs and symptoms of osteomalacia

bone pain and tender, proximal mm weakness, hypocalcemia, pseudofractures and pathological fractures, bowing of femurs/tibs, waddling

on radiographs, osteomalacia looks like

osteopenia, so bone biopsy can evaluate integrity

treatment of osteomalacia if caused by diet deficit

vit d and calcium supplements

-EXERCISE

treatment of osteomalacia if caused by malabsorption

correct that cause, either gastric or intestine

-EXERCISE

consequences of osteomalacia for PT (4)

impaired bone health, incorporate exercise, balance/falls assessment, reinforce diet

Pagets disease cause

progressive, unknown cause but often inherited by autosomal dominant pattern, over 50yo

what is pagets disease (Osteitis deformans)

increased bone resorption by osteoclasts

what 3 things occur because of increase resorption

large but weak bones, execessive bone formation, high turnover but excess bone lacks stability

blood levels in pagets

calcium and phosphate normal, elevated alkaline phosphatase

pain in pagets

headache, muscular, radicular

muscular concerns in pagets

pain (myalgia), stiffness

skeletal concerns in pagets

boen pain, oa, fractures, deformities (waddle, vertebrae compression, bone thick, bowing, kyphoscoloisis)

neurologic in pagets

nerve compression, confusion, deteriorating cognitive function, sensorioneural hearing loss

cardiovascular in in pagets

increased CO, vascularity, heart failure

other main things in pagets

fatigue, tinnitus, dizzy, vertigo

pagets physical manifestations

longer arms, bulging cranium with normal face, coxa varus, acetabular protrusion, outward femurs, forward tibs

dx of pagets

hard, early symptoms are vague, blood test for Alkaline phosphatase (over produced), based on radiology

goal of treatment in pagets

normalize bone heath and normalized alkaline phosphatase in blood

treatment in pagets

biophosphonates, NSAIDS to control pain, joint replacements, occipital craniectomy

role of PT within pagets

fall risk and balance assessment, post op fracture care, strengthening, aerobic activity to counter CV concerns, avoid running/jump/jog or bending/twisting if spine

when to refer pagets to MD

presents with vague diffuse body aches combined with headaches, hearing loss, tinnitus