Physiology
Endocrine
Regarding osteomalacia, which of the following statements is CORRECT:
Answer:
Osteomalacia is a disorder of mineralisation of bone matrix leading to soft malleable bone. Rickets is a disorder of defective mineralisation of cartilage in the epiphyseal growth plates of children. Osteomalacia is caused by impaired bone metabolism primarily due to inadequate levels of available phosphate, calcium, and vitamin D, or because of resorption of calcium. The most common cause of osteomalacia is a deficiency of vitamin D. Features of osteomalacia include:- Bone pain (particularly bone, pelvis, ribs)
- Neuromuscular dysfunction (particularly in the gluteal muscles, leading to waddling gait)
- Pseudofractures on x-ray (looser zones)
- Elevated alkaline phosphatase, hypocalcaemia and low phosphate due to secondary hyperparathyroidism
Osteomalacia
Physiology / Endocrine / Calcium and Bone
Last Updated: 21st April 2019
Osteomalacia is a disorder of mineralisation of bone matrix leading to soft malleable bone. Rickets is a disorder of defective mineralisation of cartilage in the epiphyseal growth plates of children.
Osteomalacia is caused by impaired bone metabolism primarily due to inadequate levels of available phosphate, calcium, and vitamin D, or because of resorption of calcium. The most common cause of osteomalacia is a deficiency of vitamin D.
Clinical Features
Features of osteomalacia include:
- Bone pain (particularly bone, pelvis, ribs)
- Neuromuscular dysfunction (particularly in the gluteal muscles, leading to waddling gait)
- Pseudofractures on x-ray (looser zones)
- Elevated alkaline phosphatase, hypocalcaemia and low phosphate due to secondary hyperparathyroidism
Features of rickets include:
- Bowing of tibia
- Poor growth
- Pain in spine, pelvis, legs
- Projection of sternum and chest wall deformities
- Back deformities e.g. kyphosis
Management
Management includes reversal of risk factors, increased dietary intake, correction of hypocalcaemia and vitamin D replacement.
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
