Osteomalacia and rickets
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Osteomalacia and rickets
Pathology
Bone disorders
Osteomyelitis
Bone tumors
Chondrosarcoma
Osteochondroma
Achondroplasia
Arthrogryposis
Cleidocranial dysplasia
Club foot
Craniosynostosis
Flat feet
Genu valgum
Genu varum
Osteogenesis imperfecta
Pectus excavatum
Pigeon toe
Lordosis, kyphosis, and scoliosis
Osteomalacia and rickets
Osteopetrosis
Osteoporosis
Osteosclerosis
Paget disease of bone
Musculoskeletal injuries and trauma
Degenerative disc disease
Sciatica
Spinal disc herniation
Spondylolisthesis
Spondylolysis
Achilles tendon rupture
Anterior cruciate ligament injury
Iliotibial band syndrome
Meniscus tear
Patellar tendon rupture
Patellofemoral pain syndrome
Sprained ankle
Unhappy triad
Compartment syndrome
Rhabdomyolysis
Carpal tunnel syndrome
Erb-Duchenne palsy
Klumpke paralysis
Sciatica
Thoracic outlet syndrome
Ulnar claw
Winged scapula
Carpal tunnel syndrome
Dislocated shoulder
Erb-Duchenne palsy
Klumpke paralysis
Radial head subluxation (Nursemaid elbow)
Rotator cuff tear
Thoracic outlet syndrome
Ulnar claw
Winged scapula
Musculoskeletal system pathology review
Back pain: Pathology review
Bone disorders: Pathology review
Bone tumors: Pathology review
Gout and pseudogout: Pathology review
Muscular dystrophies and mitochondrial myopathies: Pathology review
Myalgias and myositis: Pathology review
Neuromuscular junction disorders: Pathology review
Pediatric musculoskeletal disorders: Pathology review
Rheumatoid arthritis and osteoarthritis: Pathology review
Scleroderma: Pathology review
Seronegative and septic arthritis: Pathology review
Sjogren syndrome: Pathology review
Systemic lupus erythematosus (SLE): Pathology review
Assessments
Osteomalacia and rickets
Flashcards
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USMLE® Step 1 questions
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High Yield Notes
16 pages
Flashcards
Osteomalacia and rickets
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Questions
USMLE® Step 1 style questions USMLE
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Image reproduced from Radiopedia
Which of the following set of laboratory findings will be most likely present in this patient?
External References
First Aid
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2016
Calcium
in osteomalacia/rickets p. 473
Hypophosphatemic rickets p. 57
Osteomalacia/rickets p. 473
Parathyroid hormone (PTH) p. 336
osteomalacia/rickets p. 473
Rachitic rosary p. 473
Rickets p. 473
Fanconi syndrome p. 719
hypophosphatemic p. 617, 617
inheritance p. 57
lab values in p. 474
vitamin D deficiency p. 68
Vitamin D deficiency p. 350
osteomalacia/rickets p. 473, 473
Transcript
Content Reviewers
Bone softening caused by a faulty process of bone mineralization manifests as either rickets in children or osteomalacia in adults.
Inadequate bone mineralization could be due to a deficient or impaired metabolism of vitamin D, phosphate or calcium.
But first, a bit about bones. Now, long bones, like the femur, are made up of two epiphyses, which are its ends, and the diaphysis, which is the shaft.
Between each epiphysis and the diaphysis, there’s a region called the metaphysis.
And the metaphysis contains the epiphyseal plate, or the growth plate, which is the part of the bone that grows during childhood.
Once growth stops, the growth plate is replaced by an epiphyseal line, and this is known as epiphyseal closure.
Now, for bones to grow and develop properly, special bone cells, called osteoblasts, are hard at work.
To build bone, osteoblasts secrete osteoid, which is an organic matrix made of type 1 collagen.
These collagen fibers are the framework for the osteoblasts' work.
Osteoblasts then deposit calcium and phosphate crystals into the framework.
This process is called bone mineralization, and it confers strength to the growing bones.
Bone mineralization is dependent on an enzyme called alkaline phosphatase - which increases in response to osteoblast activity.
So, at the end of the day, bones are like a storage warehouse for calcium and phosphate.
Now, the levels of calcium and phosphate in the bone, but also in the blood, are regulated by vitamin D and parathyroid hormone, or PTH.
Vitamin D-wise, two steps are necessary for optimal metabolism: first, there must be enough vitamin D in the body, either from food, or created in the skin in response to sunlight exposure.
Summary
Rickets and osteomalacia are conditions characterized by bone softening due to a calcium deficiency or lack of vitamin D. The main difference between the two is the age at which they occur. Osteomalacia affects adults, whereas rickets affects children.
The key symptoms are diffuse bone and joint pain, proximal muscle weakness, bone fragility, and increased risk of fractures with minimal trauma. For rickets, there may also be craniotabes( softening and thinning of skull bones). The treatment typically involves vitamin D supplementation and treating the underlying cause.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
- "The Developmental Basis of Skeletal Cell Differentiation and the Molecular Basis of Major Skeletal Defects" Biological Reviews (2008)
- "Triradiate deformity of the pelvis in Paget's disease of bone." Postgraduate Medical Journal (1980)
- "Vitamin D supplementation in pregnancy: a systematic review" Health Technology Assessment (2014)
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