Osteomalacia: Causes, Symptoms and Treatment

Osteomalacia is a disorder of diminished mineralization that results in a bone breakdown quicker than it can re-form. It is also understood as the condition that softens the bones. In children, the condition is termed rickets.

This disease is primarily caused by a lack of vitamin D, which helps the body absorb calcium. Low vitamin D levels in the blood can cause low blood calcium. Calcium is essential in the blood to maintain bone strength and hardness. Insufficiency of calcium in the blood can weaken and soften the bones. 

Conditions leading to Osteomalacia

We get Vitamin D from the food we eat or is produced by the skin when exposed to sunlight. People who reside in regions with little exposure to sunlight, stay indoors, work in closed surroundings during daylight hours, wear clothing that covers most of their skin, brace dark skin pigmentation, or use very strong sunscreens may have low vitamin D production by the skin.

An individual may also not get enough vitamin D from the diet if they are lactose intolerant (have a problem digesting milk products), do not consume milk products (frequent in elderly), consume a vegetarian diet, or are unable to absorb vitamin D because of gastrointestinal disease or gastric bypass surgery.

Apart from Vitamin D deficiency, other conditions also may cause osteomalacias like cancer (rare tumors that lead to low phosphate levels in the kidney), kidney failure and acidosis, phosphate deficient diet, a liver condition where the liver is unable to transform vitamin D to its active form or from the adverse effects of the drugs used to manage seizures.

Sign and Symptoms of Osteomalacia

Osteomalacia may lead to several clinical symptoms, the most common being bone fractures without a real injury. Apart from fracture, the most common symptom of osteomalacia is Bone pain, especially in the hips. This dull, aching pain can spread from the hips to the lower back, pelvis, legs, and ribs. Patients with osteomalacia may also suffer muscle weakness and experience difficulty walking or show a waddling gait due to pain and fractures.

Furthermore, those with deficient blood calcium levels may also experience irregular heart rhythms, and numbness around the mouth, arms, and legs, along with spasms in the hands and feet.

Diagnosis and Treatment 

For establishing the diagnosis of osteomalacia, blood tests are crucial. A lab test estimates vitamin D, creatinine, calcium, phosphate, electrolytes, alkaline phosphatase, and parathyroid hormone levels. Osteomalacia or another bone disorder mainly features low vitamin D, calcium, and phosphorus levels. However, in osteomalacia, alkaline phosphatase isoenzymes levels are high.

In osteomalacia cases, x-rays and bone density examinations aid in detecting pseudofractures, bone loss, and softening of the bones. It is important to remember that osteomalacia mimics the weakening of the bones, like osteoporosis on bone density testing. Rarely, the doctor may advise a bone biopsy, in which a sample of bone tissue is taken and examined.

Osteomalacia is treated by orally supplementing vitamin D, calcium, and phosphorus. People with certain conditions may require regular blood tests to monitor blood levels of phosphorus and calcium. People who cannot absorb nutrients adequately through the intestines, like those with weight loss surgery, may need larger vitamin D and calcium doses. Thus, consuming vitamin D and a calcium-rich diet and obtaining adequate sunlight can thwart osteomalacia due to vitamin D deficiency. The physician may also advise wearing braces to reduce or prevent bone irregularities and, in severe cases, surgery for repairing bone deformities.

Some people with vitamin deficiency disorders get better within a few weeks. It usually takes six months for the body to heal after treatment.

Clinical Complications Associated with Osteomalacia

Clinical complications associated with osteomalacia can include bone pain and tenderness, increased risk of bone fractures, muscle weakness and wasting, difficulty walking, and decreased bone mineral density. Osteomalacia can also lead to cardiac and pulmonary complications, including hypertension, arrhythmias, and heart failure, as well as respiratory failure. Additionally, osteomalacia may be associated with an increased risk of developing other serious medical conditions, such as cancer, diabetes, and kidney disease. Treatment of osteomalacia typically involves restoring Vitamin D levels, calcium supplementation, and physical therapy.

Untreated cases of osteomalacia may suffer complications -

• Adults can experience frequent fractures of bones like rib, leg, and spine bones.

• Children may experience co-occurrence of both osteomalacia and rickets, leading to bowing of the legs or premature tooth loss. 

• Symptoms tend to return in cases with insufficient vitamin D or if they stop taking supplements or don't address underlying conditions like kidney failure.

Summary-

Osteomalacia is a common medical condition that affects the bone, compelling them to weaken and cause pain. It is necessary to notice the symptoms of the disease and approach the physician at the earliest to seek treatment and thwart further fractures or weakening of the bone.

Furthermore, it is also crucial that the individuals take adequate vitamin D and calcium through diet, supplements, or optimal sunlight exposure.