Osteomalacia

Osteomalacia is a condition in which the bones are softened due to vitamin D deficiency. This condition happens due to improper mineralizations of the bone matrix. Disorders of vitamin D metabolism and lack of its absorption plays a significant role in resulting osteomalacia.

Clinical manifestations of osteomalacia include skeletal deformities which are identified post fractures. Bone density is reduced to a larger extent which is associated with the loss of trabeculae and thinning of cortices. Significant X- ray determination includes radiolucent bands referring to pseudo fractures perpendicular to the femur, pelvis and scapula. Muscle weakness and achy bones are also associated with osteomalacia. The level of serum calcium and phosphorus is altered depending upon the cause of the disease. Osteomalacia in turn causes secondary hyperparathyroidism.

The symptoms of osteomalacia include loss of muscle density and strength, sharp pain or achy bones , gait and decreased physical activity. These symptoms are often noticed in the regions of hip, arms, legs, lower back and also ribs. Although osteomalacia is associated with vitamin D absorption disorder in the body, there are other conditions such as gastrectomy, celiac disorders which play a major role in the disease progression. The predominant reason for osteomalacia among patients who have undergone gastrectomy or having autoimmune disorders of the small intestine is due to the impairment of vitamin D absorption in these parts of the body. Other than these causes, osteomalacia can also be associated with drugs such as phenobarbital.

Since osteomalacia is associated with vitamin D deficiency, the treatment includes oral administration of ergocalciferol 50,000 international units for a period of eight weeks. This treatment is followed by continuous intake of 800 IU of vitamin D associated with maintenance therapy. Osteomalacia caused due to malabsorption requires higher doses of ergocalciferol ranging from 100,000 IU biannually. The intake of vitamin D should be supported by calcium supplementation. Subsequently in order to monitor the progress of prophylaxis, the serum and urinary calcium levels are monitored. The normal value for the 24 hour urinary calcium is 100-250mg/24hr.

Hypoparathyroidism

Hypoparathyroidism is a medical condition that occurs due to insufficient levels of parathyroid hormone. Hyperparathyroidism can lead to abnormal levels of calcium and phosphorus in the blood. The blood levels of calcium dip and the levels of phosphorus rise. Hypoparathyroidism can occur due to injury to the parathyroid glands. Underdevelopment of parathyroid glands at birth, radiation therapy or other medical conditions can lead to Hypoparathyroidism. The congenital absence of the parathyroid glands leads to a disease known as DiGeorge syndrome.

A patient suffering from Hypoparathyroidism may notice tingling in the arms and feet and muscle spasms. The skin and hair becomes dry and the nails become brittle. Hypoparathyroidism can bring on convulsions or cataract. There may be dental complications and painful menstruation. Children suffering from Hypoparathyroidism suffer from vomiting and headaches. There may be improper development of the teeth. The patient is likely to suffer from fungal infections. Persons suffering from Hypoparathyroidism may suffer from cardiac arrhythmia.

Blood tests are conducted to measure the levels of parathyroid hormone. X-rays and CT scans will reveal any bone abnormalities due to insufficient calcium. Calcium injections or Vitamin D tablets can provide relief to a person suffering from Hypoparathyroidism. A diet rich in calcium and low in magnesium is suggested.

Hypophosphatemia

Hypophosphatemia is a condition wherein the blood phosphorus levels fall below 0.8 mmol/L. The normal blood phosphorus range is about 0.8 to 1.4 mmol/L in adults and slightly higher in children. Phosphorus plays an important role in energy formation and storage, nerve conduction, kidney function and formation of teeth and bones. Good dietary sources of phosphorus include meats, whole grain breads and cereals.

Typical symptoms of hypophosphatemia include bone pain, muscle weakness, confusion, seizures and anemia. Muscle cramps and Rhabdomyolysis are other symptoms. Certain medications like birth control pills, anabolic steroids and diuretics can cause hypophosphatemia. Hyperparathyroidism, Vitamin D deficiency and alcoholism can lead to this condition. When the levels of phosphorus fall too low, it can lead to easy bleeding and increased instances of infection. Kidney function test and Vitamin K blood test are conducted. Weak bones might be noticed on X-rays. Anemia and heart damage (Cardiomyopathy) is sometimes noticed.