DR Medhat MRCP

Osteomalacia
Def : - Defective miniralisation of bone ( normal bone matrix but ↓ miniral content).
- If in children → Rickets → permanent deformities.
- If in adults → Osteomalacia.
Causes :
A. Insufficient or inefficient vitamin D:
1. Low intake in diet
2. Mal absorption syndrome (e.g celiac disease, bowel resection).
3. Decrease sunlight exposure.
4. Increased clearance : enzyme inducers e,g anticonvulsants.
5. Renal failure (lack of activation)
‏(سؤال مهم 6. Vitamin D resistant; inherited (X-linked dominant
7. Liver disease, e.g. Cirrhosis.
B. Hypophosphatemia : (antacids , Fanconi syndrome , RTA, hypophosphatemic rickets)
C. Disorders of bone matrix : fibrogenesis imperfecta ossium.
Mercury poisoning or any heavy metal poisoning causes an acquired Fanconi syndrome
سؤال with distal renal tubular acidosis can cause osteomalacia
Clinical picture :
A. C/P of rickets ( i.e in children) :
- Short stature
- Craniotabes (i.e soft occipital bone)
- Prominent frontal & parietal bones.
- Delayed teething
- Ricketic Rosary (enlarged costocondral junctions),pigeon chest.
- Bow legs
- Knock knee
- Enlarged metaphysis of long bones especially lower end of radius.
Enlarged metaphysis of long bones
Ricketic rasary