In this essay we will discuss about the Osteomalacia:- 1. Clinical Features of Osteomalacia 2. Diagnosis of Osteomalacia 3. Treatment 4. Prognosis 5. Prevention.
Contents:
- Essay on the Clinical Features of Osteomalacia
- Essay on the Diagnosis of Osteomalacia
- Essay on the Treatment of Osteomalacia
- Essay on the Prognosis of Osteomalacia
- Essay on the Prevention of Osteomalacia
Essay # 1. Clinical Features of Osteomalacia:
a. Deformities of the spine, pelvis and legs are now rarely seen.
b. The common features are pain and muscular weakness. Pain ranges from a dull ache to severe pain. The affected sites are the ribs, sacrum, lower lumbar vertebrae, pelvis and legs.
c. Bone tenderness on pressure is common.
d. Muscular weakness is often present and the patient may find difficulty in climbing stairs or getting out of a chair.
e. Spontaneous fractures may occur.
f. Tetany may be manifested by carpopedal spasm and facial twitching.
Essay # 2. Diagnosis of Osteomalacia:
The early symptoms may resemble those present in osteoporosis and rheumatic disorders. The measurement of plasma 25 (OH) D should clear the diagnosis. The distinction between osteomalacia and osteoporosis.
Essay # 3. Treatment of Osteomalacia:
a. A daily oral dose of 25-125 mg (1,000- 5,0001.U.) of Vitamin D cures rickets and osteomalacia. This should be reduced to 10 µg, the prophylactic dose, when plasma alkaline phosphatase has returned to normal and radiographs show that healing is established.
b. Children can be given halibut liver oil in a very small dose ( 1 ml) since it contains 30 to 40 times the concentration of Vitamin D of cod-liver oil. For severe cases, synthetic calciferol is useful.
c. When an infant or young child may be seen once by an emergency medical service and perhaps not again for months, a single massive dose of Vitamin D (150,000 I.U.) (three strong calciferol tablets) can be given by mouth with reasonable safety and curative effects. The single dose can be given by injection but this has no proved advantage over the oral route. A daily small dose is recommended to avoid danger of over dosage.
d. If there is evidence of malabsorption in osteomalacia, the dose of Vitamin D should be up to 1.25 mg (50,000 I.U.) daily and it may have to be given intramuscularly at weekly or monthly intervals. If the disease is secondary to kidney or liver disease large doses and either 1, 25 (OH)2D or 25 (OH) D are indicated.
e. An adequate intake of calcium is essential. The best source is milk and at least 500 ml should be drunk daily. When this is not practical and in severe cases, calcium lactate, taken by mouth, should be prescribed.
f. An egg and butter daily is required to increase the dietary intake of Vitamin D.
g. Mothers of young children require tactful education in feeding and general care, as do elderly patients.
h. Unnecessary clothing should be removed and there should be every opportunity to go out to enjoy the sunshine.
Essay # 4. Prognosis of Osteomalacia:
Rickets is not a fatal disease but the untreated rachitic child is a weakling with an increased risk of infections, notably bronchopneumonia. The skeletal changes usually tend to heal spontaneously as the child gets older.
The bony deformities, if mild, usually right themselves as growth proceeds, but in severe cases pigeon chest, contracted pelvis, knock knees or bow legs may persist. With early and sufficient treatment these changes are entirely avoided. In osteomalacia, Vitamin D quickly relieves the pain and muscular weakness but it takes many weeks or months to restore the bones to their normal strength.
Essay # 5. Prevention of Osteomalacia:
a. All people can be protected from rickets by a supplement of 10 µg of Vitamin D daily. The dose is effective and safe. Supplements are necessary in all countries with long dark winters for all children up to 5 years of age, and for their mothers during pregnancy and lactation.
All children on anticonvulsive drugs should continue to receive a supplement. In some communities there is now evidence that large numbers of the elderly require extra Vitamin D to protect them against osteomalacia.
b. Rickets occurs predominantly in families which are poor and where the mother lacks education. An intensive programme of health education is needed to ensure that the supplements are taken regularly; this should also provide advice on diet, clothing and general hygiene.
c. Children in countries with abundant sunlight should not normally need a Vitamin D supplement. Where rickets is present, teaching of mother craft, emphasizing that young children must not be excessively protected from the sun, is necessary, protein-energy malnutrition is sometimes associated with rickets and routine dietary supplement may be needed.
d. In tropical countries, fish-liver oils are more easily obtained. They contain useful amounts of Vitamin A. Sometimes it may be advantageous to give children a single massive dose (1 -2 mg) of Vitamin D. This is stored in the liver, liberated slowly and protects a child for several months.
e. Smoke abatement, slum clearances, and provision of open-air playgrounds were mainly responsible for the marked fall in the prevalence of rickets in the early part of the present century. The great improvement in these matters have to be maintained and extended where necessary. These are public health measures of major importance.