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Osteomalacia and Rickets

Osteomalacia and Rickets. Vitamin D (cholecalciferol). Sources of vit D Diet u.v. light on precursors in skin Normal daily requirement 400-800 IU/day Target organs bone - increased Ca release gut - increased Ca absorption. Normal metabolism Vit D 25-HCC (Liver) Ca/PTH

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Osteomalacia and Rickets

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  1. Osteomalacia and Rickets

  2. Vitamin D (cholecalciferol) • Sources of vit D • Diet • u.v. light on precursors in skin • Normal daily requirement • 400-800 IU/day • Target organs • bone - increased Ca release • gut - increased Ca absorption

  3. Normal metabolism Vit D 25-HCC (Liver) Ca/PTH 1,25-DHCC 24,25-DHCC (Kidney) (Kidney)

  4. Actions of vitamin D • Kidney • decreased Ca2+ excretion • Bone • increased bone mineralization • Small bowel • increased Ca2+ and PO42- absorption

  5. Osteomalacia • Equivalent to Rickets in children • Definition: • Inadequate mineralization of bone • less mineralization per unit volume of bone

  6. Osteomalacia: causes • Vit D deficiency • low intake plus inadequate sunlight exposure • malabsorption • Abnormal vit D metabolism • Liver disease • Renal disease • Drugs (anticonvulsants) • Hypophosphatemia • Low intake • Genetic

  7. 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)

  8. Osteomalacia: clinical manifestations • malaise • Bone pain • Proximal muscle weakness • Abnormal gait (waddling gait) • Hypocalcaemia

  9. Osteomalacia: Diagnosis • Ca • P • ALP • Urine Ca • PTH

  10. Rickets

  11. frogleg view looser’s zone AP view looser’s zone

  12. Normal Osteomalacia

  13. 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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