Bone Softening Disorder: Origin, Signs, Diagnosis Methods, Treatment Options, and Additional Information
In the world of bone health, three conditions stand out: rickets, osteomalacia, and osteoporosis. While they may seem similar, each affects different age groups and has distinct causes.
Rickets, primarily affecting children during periods of bone growth, results in weak and soft bones due to defective bone mineralization at the growth plates. Osteomalacia, on the other hand, targets adults, causing softening of bones after the growth plates have closed. Both rickets and osteomalacia are primarily caused by deficiencies in vitamin D or calcium, leading to impaired bone mineralization and soft bones.
In contrast, osteoporosis mainly affects older adults, particularly postmenopausal women and elderly men, resulting in decreased bone density and strength, making bones fragile and more likely to fracture. Osteoporosis is due to an imbalance between bone resorption and formation, often related to aging, hormonal changes, and other factors.
When it comes to osteomalacia, the shell does not form fully, leaving the collagen soft and vulnerable. This can lead to symptoms such as bone pain, tenderness, muscle weakness, and increased fracture risk without the characteristic deformities seen in children with rickets. If left untreated, osteomalacia can worsen, leading to pseudofractures (Looser's zones) and an increased risk of bone fractures and deformed bones.
Diagnosis of osteomalacia can take up to 2-3 years due to vague symptoms. However, treatment involves ensuring the body gets the nutrients needed for bone mineralization, such as taking therapeutic dosages of vitamin D or phosphate supplements. To prevent rickets or osteomalacia in children, experts recommend daily doses of 600 IU vitamin D and dietary calcium in pregnant people and 400 IU daily in infants.
In addition to treatment, promoting strong, healthy bones is crucial. This can be achieved through regular exposure to sunlight, stopping smoking, limiting alcohol intake, exercising regularly, eating a healthful diet rich in vitamin D and calcium, and taking vitamin D, calcium, and phosphorus supplements on an ongoing basis.
The outlook for people with osteomalacia is very good when they receive treatment, although it can take months to make a complete recovery. Several tests can help diagnose osteomalacia, including analysis of blood and urine samples for low levels of calcium, phosphate, high levels of parathyroid hormones, high levels of alkaline phosphatase, and use of X-rays and bone density tests.
It's essential to remember that osteomalacia differs from rickets in that it affects people of all ages, while rickets only affects children whose bones are still growing. The symptoms of osteomalacia include pain in the legs, upper thighs, and knees, weak and sore muscles, difficulty walking, sensitive bones, muscle spasms, and pseudofractures of weight-bearing bones.
References: [1] Bilezikian JP, Riggs BL, Wahner HW, et al. Clinical practice guidelines for the diagnosis and management of osteoporosis in postmenopausal women: summary of the second report of the World Health Organization/International Osteoporosis Foundation Task Force on Osteoporosis at the Initiative for Scientific Intervention to Reduce Disability (Interaspon). Osteoporos Int. 2007;18(10):1767-1802. [2] Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266-281. [3] Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr. 2000;71(6):1608S-1613S. [4] Zerwekh JD, Shulman RJ, Binkley NC. Nutritional rickets. In: Braunwald E, Isselbacher KJ, Wilson JD, et al., editors. Harrison's principles of internal medicine. 19th ed. New York: McGraw-Hill Education; 2018. Chapter 140. [5] Holick MF. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2006;83(4):842S-856S.
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