Detecting and treating osteomalacia

Osteomalacia is a mineral-losing bone disease that has diffuse properties. Acquired disease, encountered in adults, is characterized by a defect in the process of inorganic mineralization of bone proteins.

The main reason is due to lack of vitamin D. Bone becomes soft, easy to deform, easy to break.

The role of vitamin D in the body's skeletal system

Image of osteomalacia (Photo: TTO) Dissolved vitamin D in fat mainly comes in two forms: vitamin D2 found in yeast or vitamin D3 formed in human skin when sun exposure (ultraviolet rays), found mainly in fish liver oil and egg yolk. Milk is rich in both forms of vitamin D. Synthetic skin is the main source of vitamin D.

Vitamin D is a pre-hormone, producing many metabolites that act like hormones. The main function of vitamin D is to increase calcium absorption from the intestine and carry out normal bone formation and bone mineralization. Especially in bone, vitamin D stimulates more synthetic cells than alkaline phosphatase and osteocalcin (vitamin K-dependent bone protein), and less than collagen, all of which facilitate bone formation.

The main causes of osteomalacia

Osteomalacia may occur when insufficient vitamin D supply, metabolism of vitamin D disorders, or tissue no longer sensitive to it. Osteomalacia is common in elderly people with less sun exposure, or diets that are deficient in vitamin D. Osteomalacia is also caused by gastrointestinal absorption of vitamin D or metabolic disorders such as duodenal gastrectomy, Intestinal cut, chronic intestinal disease, hepatopancreas, bile, malabsorption syndrome, renal failure, hypoparathyroidism.

It should be noted that some high-dose, long-term oral medications may cause osteomalacia such as antiepileptic drugs (phenobarbital, phenyltoin), fluoride, biphosphonate (etidronat), acid-reducing drugs containing aluminum (aluminum hydroxide).

In addition, phosphorus metabolism disorders can also cause osteomalacia (diabetes mellitus). For example, Fanconi syndrome, a tubular disease, causes excessive renal excretion of the phosphorus, reducing blood phosphorus.

Vitamin D deficiency causes decreased absorption of calcium through the gastrointestinal tract, hypocalcemia, secondary hyperparathyroidism, bone mineralization disorder. Mineral loss occurs, especially in the spine, pelvis, lower extremities. Due to soft bones, body weight has bent long bones, subsidence of vertebrae, flattening of the pelvis, narrowing of the pelvis.

Diagnosis of osteomalacia

Clinically, osteomalacia needs to be considered in the following cases:

- Disseminated bone pain and bone pain when pressed. Groin pain affects the gait. Pelvic pain, chest pain, shoulder blades, spine ., began to simmer, gradually becoming persistent and frequent.

- Impaired motor function due to pain and reduced root pressure, walking disorders, waddling or even bedridden.

- Bone deformity and fracture, in the late stage. Osteomalacia may suggest a fracture after a minimal injury.

- Tetani seizures caused by rickets caused by hypocalcemia.

Patients need to be photographed with X-ray of damaged bones to detect specific signs such as disseminated osteoporosis, combined with loss of bone and thin bones, and Looser - Milkmann line.

Tests showed hypocalcemia, hypoglycemia, decreased vitamin D blood, hyperparathyroidism, increased blood alkaline phosphatase and hypocalcemia.

Thus, the main clinical symptoms and tests are changes in blood calcium, alkaline phosphatase, and the level of 25 (OH) D3 and X-ray to confirm the diagnosis of osteomalacia. In addition, it is necessary to diagnose the cause of osteomalacia. Vitamin D deficiency is the most common cause. The cause of drug use is also not ignored. Rarely is the cause of phosphorus metabolism disorders.

Treatment of osteomalacia

Patients with osteomalacia should be supplemented with vitamin D. Treatment in batches, depending on the cause and severity of the disease. Note that 1mcg of vitamin D is equivalent to 40v. In osteomalacia due to deficiency of vitamin D, vitamin D2 (ergocalciferol) or vitamin D3 (cholecalciferol) take 800-4,000DV daily for 6-12 weeks, then use maintenance dose of 200-600v. Elderly people may need up to 50,000vnd per week for 8 weeks to treat vitamin D deficiency.

Osteomalacia due to poor absorption requires higher doses of vitamin D, even up to 100,000v / day, combined with calcium (4g calcium carbonate / day). In patients taking antiepileptic drugs, need to take more vitamin D. Calcitriol (0.25- 1mcg taken 4 times / day) is effective to treat hypocalcemia or osteodystrophy due to chronic kidney failure. In addition, it is necessary to stop drugs that can cause osteomalacia as well as adding phosphorus if phosphorus metabolism is disturbed.