Osteomalacia

Osteomalacia occurs due to Vitamin D deficiency.

1. Dietary vitamin D deficiency and lack of sun exposure are the most common causes of osteomalacia.
2. Gastrointestinal disease or post-surgical states with altered intestinal absorption of vitamin D.
3. Chronic kidney disease
4. Renal tubular acidosis – Proximal type 2 renal tubular acidosis
5. Exposure to inhibitors of bone mineralization – Aluminium toxicity, endemic fluorosis

Most people with osteomalacia are asymptomatic in the early stages of the disease.

Symptoms may be insidious in onset and can occur in the later stages of the disease.

Some of the symptoms are:

1. Bone pain—mainly in the lower spine, pelvis, and lower extremities as well as at sites of fracture. The pain is dull and aching and is worsened by activity and weight bearing.
2. Muscle weakness – is usually proximal and may be associated with muscle wasting and discomfort with movement. This can cause a waddling gait.
3. Fractures with minimal or no trauma – this involves the ribs, vertebrae, pelvis, and long bones.
4. Bone deformity

Dr Reena Thomas will diagnose this condition with a comprehensive medical evaluation and physical examination. She will order the relevant blood tests to check the blood levels of calcium, phosphate, alkaline phosphatase, 25-OH vitamin D, PTH, kidney function, and electrolytes. This will help determine the cause of osteomalacia and guide treatment. She will arrange for you to have imaging studies like bone density scans. She may arrange for you to have a transiliac crest bone biopsy, which is done at specialist centers only and is the gold standard for confirming the diagnosis of osteomalacia.

Dr Thomas will review and discuss all your symptoms and the results of the blood tests and imaging studies with you. The treatment of osteomalacia depends on the underlying cause. Optimal replacement with Vitamin D supplements, avoiding bone-altering medications like bisphosphonates, and increasing calcium supplementation.

Dr Thomas will perform a comprehensive medical evaluation, including a detailed physical examination. She will monitor your blood levels of calcium, phosphorus, vitamin D, and bone mineral markers at regular intervals. She will arrange for you to have urine studies and bone mineral density scans to monitor the impact of the different treatments on your bone strength.