Osteomalacia isn’t a rare condition – people all over the world get affected by it. In fact, in US alone 1 out of 1000 suffer from this discomforting condition in which bones of an adult gets soft and cause problems like muscular weakness and pain. Out of the 20-25 million US citizens that suffer from this condition, around 25% are post-menopausal women. In kids, the soft bones condition is known as Rickets and could be due to environmental, genetic or dietary factors. Mostly, it is because of low level of Vitamin D in the diet.
This condition is confused with another condition called Osteoporosis which is caused by deficiency of calcium. During this disorder, there is an abnormal loss of the bony tissue in the body and it is generally in women past their menopause stage. Osteomalacia, on the other hand, is due to severe deficiency of Vitamin D or abnormal metabolism of the same and it results in delicate porous bones. This condition is most likely to prevail in people who take low amount of Vitamin D in the diet and avoid the Sun altogether. Also, the aged and hospital bound people with almost no activity develop Osteomalacia. Children and even adults who don’t drink milk are high at risk too.
Symptoms of Osteomalacia
There may be no symptoms in the early stages of the condition but as the situation worsens, the symptoms become clearer. Diagnostic tests like x-rays make the signs apparent; though some patients just get a general feeling of illness and not very clear-cut signs. Bone pain is a very common and it persists in most of the cases. The occurrence is gradual but it could get very painful as the disease spreads. It originates in the lower spine, hips, ribs, legs, pelvis and lower back – it is mostly dull. However, in acute cases, the pain starts in the hips and takes over the body.
In addition to that, they also get tender – even a little pressure can make the bones scream in pain, ribs and shin bones are generally affected the most. Hairline bone fracture can also cause tenderness and pain in bones and in few patients minor injury could accompany the fracture. Furthermore, patients complain of difficulty in climbing stairs or getting up of a chair. Weakness in legs and arms and decrease in motility are also witnessed too. Other symptoms are numbness in legs and arms or around the mouth, abnormal heart beat, spasms in feet and hand muscles.
Causes of Osteomalacia
Developing this condition could be due to many reasons. Sometimes, the body is unable to absorb the nutrients in one’s diet while in rest of the cases, there isn’t sufficient minerals for the body to absorb. Calcium and phosphate are used by the body in order to make the bones stronger. The softness and weakness of bones is due to lack of calcium in one’s body. Another case scenario could be insufficient vitamin D that processes calcium in a body. Less exposure to sun, being covered from head to toe while being in the Sun and living in soggy conditions are some of the reasons why people don’t get enough Vitamin D and thus, develop this condition. Hereditary or acquired disorders involving abnormal metabolism of Vitamin D and lack of phosphate in diet could also give way to Osteomalacia.
Other than that, it is also a side-effect of some anti-seizure drugs like Phenytoin and Phenobarbital. Cancer, liver diseases and kidney failure are also causes of Osteomalacia as they intervene with body’s ability to process the Vitamin D it gets. Surgically removing a part of stomach (Gastrectomy) or small intestine leads to the condition as well. People with the Celiac disease, a disorder in which lining of small intestine gets damaged, could also become victim of this condition as the healthy lining is responsible for absorbing nutrients and building a stronger body.
Diagnosis and Treatment of Osteomalacia
Diagnosis of the condition could be done using some tests. These include:
- Urine and Blood Test: Blood tests and urine tests help determine the level of phosphate, calcium & Vitamin D in the body. A twenty four-hour urinary phosphate test can check for its presence.
- Bone Biopsy: This test is not done very frequently despite the fact that it is accurate in detecting this condition. Bones soften when patient is suffering from Osteomalacia; a tiny needle penetrates the skin and a sample from bone which is studied under the microscope to check if the condition is present.
- X-ray: X-rays are performed to spot cracks in bones; these cracks are palpable in people with this condition.
- Bone Density Test: Osteomalacia reduces bone density and patients with this condition are diagnosed with low bone density. Dual Energy X-ray Absorptiometry or DEXA is the most common test that determines the bone density. Bone mineral density test checks for calcium as well as other minerals in the bone segment – this test is used to tell if patient has any risks of getting Osteomalacia or bone fractures in future. Low mineral content indicates weaker bones. In some countries, this test is restricted but a doctor could arrange it if the patients get their own density scanner. Otherwise, this test can be done in hospitals or privately.
Differential diagnosis is also done to ensure that the symptoms are not due to anything other than Osteomalacia, bone disorders like Paget’s disease or Osteoporosis.
Treating Osteomalacia involves giving supplements of Vitamin D, Calcium and Phosphate to the patient. Those who can’t absorb the nutrients are given larger doses of Vitamin D and calcium. Also, Vitamin D could be injected in the body or administered using supplements by mouth for weeks. If the condition is due to lack of exposure to sunlight or insufficient nutrients in the diet, it could be cured by raising the level of Vitamin D in the body. Kidney failure and Primary Biliary Cirrhosis are treated to recover from Osteomalacia. Also, the repeated blood tests are done to monitor the level of phosphorous and calcium in the blood.
Complications and Prevention of Osteomalacia
Recurrence is a possibility with this condition – it could come back again with similar symptoms and discomforts. Broken bones in spine, legs and ribs are especially common and in case that happens, medical attention becomes indispensable. Adding naturally Vitamin D-rich food in your diet like cereal, yogurt bread, milk, egg yolks and oily fishes could help in preventing the condition.
If you cannot implement these in your diet, you should consult your doctor and ask for Vitamin D supplements – these could prove very useful especially if you have problem in absorbing nutrients. Other than that, exposure to the sun can boost up Vitamin D level in your body; lack of exposure is one a cause of the condition and by spending adequate amount of time in the sun, you can lower the risks of getting Osteomalacia. However, you should keep in mind that spending a lot of time in the sun could have adverse effect on your health so you should consult the skin expert before you go out and get your fun in the sun.
As early as possible, you should seek medical care in case you notice persistent symptoms like numbness, trouble in moving joints and swelling. It goes without saying that if the symptoms are serious like dislocation, severe swelling and inability to sense the bone, then you need to go to a doctor without wasting a second.