Osteomalacia is a pain-causing softening of the bones. It is usually caused by a deficiency of vitamin D or calcium.
What is osteomalacia?
Osteomalacia refers to the softening of bones in the human body, often caused by a deficiency of vitamin D. In children, these symptoms are also known as rickets. Soft bones affected by osteomalacia are more likely to be injured or break than harder, healthier bones. Osteomalacia should not be confused with osteoporosis, another disorder that can also lead to bone injury. Osteomalacia results from a defect in the bone formation process, while osteoporosis refers to a weakening of the already developed bone structure. Muscle and bone pain are the most common signs and symptoms of osteomalacia. Treatment of osteomalacia involves correcting the prevailing deficiency of calcium and vitamin D; as well as targeting any underlying disease associated with the development of osteomalacia.
Causes
The human body uses calcium and phosphates to build strong bones. The disease of osteomalacia usually results from a lack of supply of these nutrients within the diet. Likewise, when the body cannot adequately process the substances. Vitamin D is made by the body when sunlight hits the skin. Vitamin D is needed to process calcium. Thus, osteomalacia can occur in people who spend little or no time in sunlight, or live in areas where sunlight hours are short or the air is highly polluted. Osteomalacia can also result from certain operations of the stomach (gastrectomy). Since the absorption of vitamin D from food is thus reduced. Celiac disease, liver or kidney damage can also lead to osteomalacia, as they disrupt essential body processes.
Symptoms, complaints, and signs
Initially, osteomalacia is manifested by muscle weakness and nonspecific bone and joint pain. As the disease progresses, the characteristic hump develops. The increasing curvature of the upper body is associated with chronic pain and restricted mobility. The visual changes can also lead to psychological complaints. Once a hump has developed, it can usually no longer be corrected, which is why the deformity represents a constant burden for those affected. As a result of the reduced bone density, there is also an increased susceptibility to fractures. The femoral neck and vertebral bones are particularly affected. If the complaints are based on malnutrition, symptoms such as weakness, fatigue and concentration disorders may develop. In addition, those affected are often emaciated and have a sickly appearance. If the cause of osteomalacia is treated at an early stage, the symptoms described normally subside. Most patients are symptom-free at the latest one to two months after the start of treatment. In the absence of treatment, bone softening leads to further fractures and deformities. In the long term, this leads to stiffening, chronic pain and eventually bed confinement. Thus, if left untreated, the disease takes a severe course associated with further symptoms and discomfort. External signs such as the hunchback described above also become more pronounced as the disease progresses.
Diagnosis and progression
To sort out the cause of osteomalacia and rule out possible other diseases, the patient may need to have the following tests performed on him or her. Blood and urine tests: If osteomalacia is caused by vitamin D deficiency or phosphate loss, these abnormal levels can be detected in the blood or urine. X-ray examination: Osteomalacia causes characteristic lesions in the bone structures that can be identified on X-ray images. Bone biopsy: During a bone biopsy, the doctor inserts a thin needle through the skin into the bone. A small sample of the bone is taken and then examined under a microscope. Even though the biopsy is very accurate for determining osteomalacia, it is rarely used.
Complications
Osteomalacia is a disease that can be prevented with adequate supply of vitamin D to the body.If the disease is present, serious complications can only be avoided with the help of intensive treatment. If left untreated, a so-called creeping pathological fracture usually develops. However, since the bones are softer here, the fractures do not occur suddenly but insidiously. They thus manifest themselves in increasing curvatures at points where increased bending stresses are present. This is how the upper body becomes curved. Particular bending stresses are also present at the neck of the femur, so that fractures of the neck of the femur can frequently occur in osteomalacia. This is especially the case in older individuals, as they have increased osteoporosis in addition to bone softening due to often severe vitamin D deficiency. Femoral neck fractures usually cause patients severe pain and lead to restrictions in mobility. The healing process usually progresses very slowly. With conservative treatment of a femoral neck fracture, there is an increased risk of leg vein thrombosis and pulmonary embolism. Due to this fact, osteomalacia may also lead to death more frequently in the elderly. For this very reason, it is important to ensure an adequate supply of vitamin D, especially in the elderly.
When should you go to the doctor?
A reduction in the general ability to exercise or limitations in the ability to move should be presented to a doctor. If there are general problems of the musculoskeletal system or a conspicuousness of posture, a visit to the doctor is advisable. A characteristic feature of osteomalacia sufferers is a crooked posture. In addition, those affected suffer from pain. The use of painkilling medication should be avoided until a doctor has been consulted. Side effects may occur, resulting in further deterioration of health. Disturbances in concentration, fatigue or tiredness should be discussed with a doctor. If the existing complaints increase in scope or intensity, a doctor should be consulted immediately. A decrease in the quality of life or a reduction in well-being should be clarified by a physician. If daily activities or sports can no longer be performed in the usual way, the affected person needs help. Stiffening of the muscular system, internal weakness, fatigue and tiredness are signs of a disease requiring treatment. If the irregularities persist for several days or weeks, a doctor is needed. If left untreated, serious health disorders will result, as well as further visual changes in the bone structure. If additional mental or emotional problems occur, a visit to the doctor is also advisable. Social withdrawal, weepiness or changes in personality should be discussed with a physician.
Treatment and therapy
When osteomalacia is caused by malnutrition or lack of sun exposure, the deficiency can be treated by simply adding vitamin D to the diet. Typically, affected patients take vitamin D supplements orally. Over the course of a few weeks or months. Less common is direct injection of vitamin D through a vein in the arm. If levels of calcium and phosphorus are also low, therapy with supplements may be prescribed here as well. In addition, treatment of an underlying condition such as renal failure or primary biliary cirrhosis also improves the symptoms of osteomalacia. Affected individuals are usually advised to increase their exposure to sunlight. Care should be taken to expose to several shorter sessions (15 minutes daily) of sunlight rather than longer irregular sessions (risk of sunburn). In advanced cases, sufferers may need to support weak bones with orthotics or correct deformed bones with surgery. Successful treatment can completely cure the effects and symptoms of osteomalacia, sometimes in as little as a few months.
Outlook and prognosis
In general, osteomalacia is a highly treatable and curable disease, although its outlook depends greatly on when the disease was diagnosed. The earlier the onset of bone softening or certain deficiencies are diagnosed and corrected by optimal therapy, the more minimal the effects of demineralization and the better the prognosis.In most cases, adequate drug treatment – taking high doses of vitamin D and calcium – achieves healing in four to six months. In this way, skeletal changes can often be reversed. In young children, existing bone deformities often correct spontaneously. Nevertheless, permanent deformities of the bones may be possible in some affected individuals. In such cases, as well as in the case of very severely deformed bones – in the case of too late diagnosis – surgical or orthopedic interventions must be performed. However, for all those affected, older people, vegetarians, as well as people with dark complexions (who enjoy less sunlight due to emigration to more northerly areas), it is still important to ensure sufficient vitamin D and calcium intake. To this end, a diet rich in vitamins (fish, cod liver oil, egg yolks, milk, dairy products) and sufficient exposure to the sun should be taken to heart. Thanks to routine prophylaxis in infancy, rickets and osteomalacia rarely occur in Europe today. Therefore, for prevention, daily supplementation with vitamin D drops over the first three years of life is of immense importance.
Prevention
Since the direct causes of osteomalacia are clearly identifiable, everyone can make a good contribution to prevention. Thus, direct exposure to sunlight should be sought regularly. 15 minutes per day is sufficient. Within the diet, too, care should be taken to consume foods with a high vitamin D content. These include: oily fish such as salmon and sardines; cereal products such as bread, or dairy products such as yogurt are also rich in vitamin D.
Aftercare
In most cases, the person affected by osteomalacia has only limited measures of aftercare available to him or her. For this reason, the affected person should consult a physician at an early stage to prevent the occurrence of further complications. In the worst case, the disease causes fractures of the bones if it is not treated properly. Those affected are usually dependent on taking various medications and preparations that can alleviate and limit the symptoms. The doctor’s instructions should also always be followed, and the doctor should always be contacted first if there are any questions or if anything is unclear. Furthermore, direct exposure to the sun should also be avoided in order not to provoke the symptoms. During the treatment, regular checks and examinations of the affected person are necessary, whereby the internal organs and especially the kidneys should also be checked regularly. In severe cases, osteomalacia requires the transplantation of a kidney, although this usually also reduces the life expectancy of the affected person. However, the further course is very much dependent on the severity of the disease and also on the time of diagnosis, so that a general prediction is usually not possible.
What you can do yourself
In osteomalacia, the first priority is to take steps to compensate for the underlying vitamin D and calcium deficiencies. Patients need to change their diet and consume foods with sufficient vitamins and minerals. For example, bananas, nuts, legumes, fish, cheese, eggs and mushrooms have proven effective. At the same time, unhealthy foods and drinks such as fast food and alcohol should be avoided. In addition, osteomalacia patients should take it easy. Too much physical activity can lead to injuries and fractures that heal slowly due to underlying bone softening. Sports activity should only take place in consultation with the orthopedist. Physical therapy is recommended, which can be supported at home by simple gymnastic exercises. In osteomalacia, bone health continues to deteriorate, which is why the affected person should use a walking aid at an early stage. Since the condition and the associated limitations can sometimes also affect the psyche, patients should seek therapy. Talking to friends and other sufferers can be helpful. The doctor can establish contact with self-help groups and, if necessary, provide tips for further self-help measures.