Rickets and Osteomalacia

Question 1

What causes Rickets and osteomalacia?

Answer 1

Severe nutritional vitamin D or Calcium deficiency causes insufficient mineralisation and thus rickets in a growing child and Osteomalacia in the adult when the epiphyseal lines are closed

Question 2

What is the difference between rickets and osteomalacia?

Answer 2

Rickets = Children, epiphyseal growth plate open

Osteomalacia = Adult, epiphyseal growth plate closed

Question 3

What is the role of Vitamin D?

Answer 3

> Stimulates the absorption of calcium and phosphate from the gut and calcium and phosphate then become available for bone mineralisation

> Muscle function is also impaired in low vitamin D states

Question 4

How does a child present with rickets?

Answer 4

> Stunted growth 
> Large forehead
> Odd curve to spine/back
> Odd shaped ribs and breast bone 
> Wide joint at elbow and wrist 
> Large abdomen 
> Odd shaped legs
> Wide bones
> Wide ankles

Question 5

Investigation within osteomalacia?

Answer 5

1) Serum 25-hydroxy vitamin D is low:
- >25 nmol/L = Vit D deficiency
- 25-50 nmol/L = Vit D insufficiency
- >75 nmol/L = Optimal

2) Low serum calcium
3) Low serum phosphate
4) Serum alkaline phosphatase is high (Osteoclast require alkaline environment)
5) May be high parathyroid hormone due to secondary hyperparathyroidism
6) X-rays show osteopenia
7) DEXA scan shows low bone density

Question 6

Treatment for osteomalacia?

Answer 6

Vitamin D (Colecaliferol)