IPHREHAB : OSTEOMALACIA & RICKETS WITH TREATMENT

IPHREHAB


OSTEOMALACIA & RICKETS

DEFINITION
It is a condition characterised  by defective bone mineralisation.
There is increased bone turnover.
It is usually due to Calcium & Vitamin D deficiency.
Condition is rare in USA, UK..
More common in Arab countries

DEFINITION

Rickets is seen in children before Puberty..

Osteomalacia is adult counterpart of Rickets..

Both have same aetiology :

There is failure or defective mineralisation of newly formed matrix

AETIOLOGY

Diet poor in calcium & Vitamin D

Malabsorption Syndromes Chronic Diarrhoea, Sprue,    Steatorrohoea, 

Tuberculosis of Intestines

Chronic  Renal Failure  

AETIOLOGY

Lack of Sunlight Exposure- Reduced Vit. D Conversion 

Hypophophatemia

Vitamin D Resistance Rickets

There is increased thickness of Osteoid Seams, reduces calcification –mineralisation is defective

VITAMIN D METABOLISM

Ultraviolet Rays 

Skin 7-DHC (dehydrocholesterol)

Vitamin D3

Liver  - converts into 25-hydroxylase

Inactive 25(OH) D3

Kidney- 25(OH) Vitamin D 1-a hydroylase

Biological Active 1,25 (OH)2 D3  

Increases absorption of calcium from gut

CLINICAL PICTURE

Delayed DEVELOPMENT-Short Stature

Decreased Muscular Tone (Hypotonia)

Craniotabes  6-12 years 

Frontal Bossing

Delayed Frontallae Closing

Enlargement of Epiphysis (Rickets Rosary)

CLINICAL PICTURE

Teeth are pitted Caries common

Pot-belly Abdomen

Carpopedal Spasms

Laryngeal Stridor

Tetany may be seen

Bone Pains – Defective spine

Waddling Gait

INVESTIGATIONS

Complete Blood Anaemia Common

Serum Calcium Low

Phosphates usually low 

Alkaline Phosphatase raised

X-ray of bones characterstic changes in children Epiphysis thined & distal end of bone widened SAUCER deformity

INVESTIGATIONS

In Adults bone X-ray may be normal or shows osteoporosis

In Children Pseudofractures & Looser’s zones (Radiolucent bands)  may be seen It affects the ribs, Axilliary border of Scapula, Pubic rami

X-Ray of Rickets

BOWED  LEGS

MANAGEMENT

Calcium 1-2 gm daily

Diet- 1 litre of milk

Vitamin D 60,000 IU (1.5 mg of D3) Daily Orally

For tetany IV Calcium gluconate is given

Response to treatment is excellent

Conservative Management

1.Dietary supplement:

2.Physiotherapy treatment :

 .Gentle range of motion exercise.

 .Gradual weaght bearing training.

 .Prevention from fall and injury.

 .Coordination and reconditioning.

 .Light endurance training.