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Adult Medical-Surgical Nursing Musculo-skeletal Module: Osteomalacia
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Bone Formation Bone is a dynamic tissue constantly reforming and resorbing Bone cells (osteocytes) are: Osteoblasts (bone formation) Osteoclasts (bone destruction, resorption, remolding)
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Bone Formation Osteoblasts secrete collagen and glycoproteins to form a bone matrix Deposit minerals in the matrix (calcium, magnesium, phosphorus, chloride) Osteoclasts resorb calcium and minerals from bone causing depletion
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Hormones Affecting Bone Turnover Hormones which promote bone formation: (inhibit resorption) Oestrogen and calcitonin Testosterone in males ( ↓ with age) Hormone which increases bone turnover and resorption: Parathormone ( ↑ with age) (Also insufficient oestrogen/ calcitonin/ testosterone)
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Factors Influencing Bone Formation Local stress: usage/ weight-bearing and walking aid bone formation (Immobility leads to increased calcium resorption from bone and osteoporosis) Adequate calcium and vitamin D (intestinal absorption of calcium) Parathormone/ Calcitonin activity Blood supply (inadequate → necrosis)
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Bone Pathology
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Bone Pathology: Classification Osteoporosis Osteomalacia Pagets Disease Bone tumour: Benign Malignant primary Metastases
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Osteomalacia: Description A metabolic bone disease Reduced mineralisation of bone leading to: Softening and weakening of bones Skeletal deformities and pathological fractures
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Osteomalacia: Aetiology Deficient activated vitamin D (calcitriol) leading to reduced absorption of calcium from the intestine, and reduced calcification and ossification of bones
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Osteomalacia: Pre-disposing Risk Factors Malabsorption syndrome: Inflammatory bowel disease/ intestinal resection/ biliary obstruction(vitamin D is fat-soluble) Renal disease: Poor activation vitamin D for calcium/phosphate absorption; calcium used to combat acidosis in renal failure Hyperparathyroidism ↓ Exposure to sunlight; malnutrition (childhood Rickets)
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Osteomalacia: Pathophysiology Reduced activated vitamin D → Reduced intestinal absorption of calcium and excessive loss of calcium from the body Low serum calcium and phosphate Demineralisation of bone (calcium resorption) with softening, weakening, deformity, fracture Muscle weakness
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Osteomalacia: Clinical Manifestations Bone pain and tenderness to touch Skeletal deformity (bowed legs, kyphosis) Waddling gait, limping Pathological fractures Vertebral compression Muscle weakness Unsteadiness, risk of falls and fracture
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Osteomalacia: Diagnosis Patient history and symptoms Xray: indicates demineralisation, fractures Low serum calcium and phosphate Raised serum alkaline phosphatase Urinary calcium and creatinine low Bone biopsy (shows increase of osteoid “pre-bone”: faulty growth)
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Osteomalacia: Medical Management Treat underlying cause if possible Sunlight Mineral supplements (calcium/ vitamin D)(avoid overdose: monitor serum calcium) ↑ dietary protein, calcium, vitamin D Gentle handling, pain relief Support (brace) or corrective surgery for deformity
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Osteomalacia: Nursing Considerations Ensure patient education about condition and means of preventing deterioration: Adequate dietary and calcium/ vitamin D supplements (note levels) Adequate sunlight Psychological/ emotional support Careful gentle handling and ensure adequate pain relief
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