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Osteomalacia and Rickets
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Vitamin D (cholecalciferol)
Sources of vit D Diet u.v. light on precursors in skin Normal daily requirement IU/day Target organs bone - increased Ca release gut - increased Ca absorption
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Normal metabolism Vit D 25-HCC (Liver) Ca/PTH 1,25-DHCC ,25-DHCC (Kidney) (Kidney)
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Actions of vitamin D Kidney Bone Small bowel decreased Ca2+ excretion
increased bone mineralization Small bowel increased Ca2+ and PO42- absorption
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Osteomalacia Equivalent to Rickets in children Definition:
Inadequate mineralization of bone less mineralization per unit volume of bone
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Osteomalacia: causes Vit D deficiency Abnormal vit D metabolism
low intake plus inadequate sunlight exposure malabsorption Abnormal vit D metabolism Liver disease Renal disease Drugs (anticonvulsants) Hypophosphatemia Low intake Genetic
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Vitamin D Deficiency risk factors
Infancy Elderly individuals with minimal sun exposure Dark skin Skin covering when outside Fat malabsorption syndromes Kidney failure Genetic disease Epilepsy (phenytoin, phenobarbitones)
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Osteomalacia: clinical manifestations
malaise Bone pain Proximal muscle weakness Abnormal gait (waddling gait) Hypocalcaemia
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Osteomalacia: Diagnosis
Ca P ALP Urine Ca PTH
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Rickets
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frogleg view looser’s zone
AP view looser’s zone
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Normal Osteomalacia
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Osteomalacia: Treatment
Treatment of Vitamin D deficiency is replacement! Oral vitamin D replacement Adults require~ 400IU/day Elderly~ 800IU/day (# prevention) Ca P
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