Krzywica i osteomalacja – Rokowania, prognozy i postęp choroby

Krzywica i osteomalacja
Rokowania, prognozy i postęp choroby

Rokowanie w krzywicy i osteomalacji jest ściśle uzależnione od etiologii, czasu trwania niedoboru oraz wieku pacjenta. Przy prawidłowej diagnostyce i wdrożeniu leczenia, rokowanie jest zazwyczaj korzystne, zwłaszcza w przypadkach niedoboru witaminy D, które są w większości całkowicie wyleczalne. Poprawa kliniczna i normalizacja parametrów biochemicznych, takich jak poziomy wapnia i fosforu, mogą nastąpić już w ciągu kilku tygodni terapii. Pełne wygojenie kości zwykle trwa około sześciu miesięcy, choć w zależności od przyczyny może się wydłużyć do ponad roku. Leczenie obejmuje suplementację witaminy D, ekspozycję na światło słoneczne oraz korektę czynników predysponujących, przy czym suplementacja fosforanów w krzywicy pokarmowej jest przeciwwskazana ze względu na ryzyko nasilenia wtórnej nadczynności przytarczyc.

Krzywica i osteomalacja – Rokowanie (przewidywanie wyników)

Czas odpowiedzi na leczenie
Czynniki wpływające na rokowanie
Leczenie a rokowanie
Diagnostyka a rokowanie
Szczególne przypadki kliniczne
Podsumowanie rokowania
Kolejne rozdziały

Krzywica i osteomalacja – Rokowanie (przewidywanie wyników)

Rokowanie w przypadku krzywicy i osteomalacji zależy głównie od przyczyny choroby, czasu trwania niedoboru oraz wieku pacjenta w momencie wystąpienia objawów. Przy odpowiednim rozpoznaniu i wdrożeniu właściwego leczenia, rokowanie jest zazwyczaj bardzo dobre.¹² Krzywica i osteomalacja to schorzenia, które można skutecznie leczyć, a w większości przypadków związanych z niedoborem witaminy D można je uznać za całkowicie wyleczalne.³

Czas odpowiedzi na leczenie

Po wdrożeniu odpowiedniego leczenia, pacjenci z krzywicą i osteomalacją mogą zauważyć poprawę w stosunkowo krótkim czasie. Wartości laboratoryjne mogą zacząć normalizować się już w ciągu kilku tygodni od rozpoczęcia terapii, podobnie jak objawy kliniczne.⁴ Pierwsze kliniczne odpowiedzi na leczenie obejmują zazwyczaj zwiększoną mobilność i wzrost siły mięśniowej, choć niektórzy pacjenci mogą doświadczać tymczasowego nasilenia bólu kości.⁵

Gojenie kości często rozpoczyna się w ciągu kilku tygodni od rozpoczęcia leczenia, ale pełne wyleczenie może trwać od kilku miesięcy do ponad roku, w zależności od pierwotnej przyczyny schorzenia.⁶⁷ Standardowo przyjmuje się, że całkowite wygojenie następuje w okresie około sześciu miesięcy przy braku specyficznej oporności na leczenie.⁸

Czynniki wpływające na rokowanie

Krzywica może prowadzić do poważnych konsekwencji zdrowotnych wykraczających poza deformacje kostne. Obejmują one zagrażające życiu powikłania hipokalcemiczne, takie jak drgawki, a u niemowląt niewydolność serca spowodowaną kardiomiopatią rozstrzeniową.⁹ Te zagrażające życiu powikłania są jednak całkowicie możliwe do uniknięcia dzięki suplementacji w grupach wysokiego ryzyka, zwłaszcza u kobiet w ciąży i niemowląt w perspektywie krótkoterminowej, oraz strategiom wzbogacania żywności w dłuższej perspektywie.¹⁰

W przypadku osteomalacji u dorosłych lub nastolatków z zamkniętymi płytkami wzrostowymi, choroba może manifestować się niespecyficznymi objawami (zmęczenie, złe samopoczucie i osłabienie mięśni) oraz nieprawidłowymi wynikami biochemicznymi krwi. Tylko w skrajnych przypadkach wiąże się z radiograficznymi objawami złamań w strefach Loosera.¹¹ Osteomalacja u dorosłych może być trudna do wykrycia wyłącznie na podstawie obrazu klinicznego.¹²

Leczenie a rokowanie

Właściwe leczenie, które obejmuje suplementację witaminy D, ekspozycję na światło słoneczne oraz korektę czynników predysponujących, powinno prowadzić do wyraźnej poprawy stanu pacjenta.¹³ W leczeniu krzywicy pokarmowej nie ma absolutnie żadnej roli dla suplementów fosforanowych; w rzeczywistości podawanie fosforanów pogarsza wtórną nadczynność przytarczyc. Odwrócenie wtórnej nadczynności przytarczyc poprzez suplementację witaminy D i wapnia poprawia poziom fosforanów w surowicy.¹⁴

Niektóre grupy pacjentów, np. osoby przebywające w długoterminowej opiece instytucjonalnej, mogą wymagać długotrwałej terapii podtrzymującej.¹⁵ Po zakończeniu leczenia niedoboru witaminy D, zmiany stylu życia i suplementacja witaminy D są prawdopodobnie potrzebne długoterminowo w celu utrzymania optymalnego poziomu witaminy D.¹⁶

Diagnostyka a rokowanie

Rozpoznanie osteomalacji musi obejmować dowody bezwzględnego zwiększenia całkowitej objętości osteoidu i zwiększonej liczby blaszek osteoidu.¹⁷ Główne kryteria histologiczne dla diagnozy osteomalacji to zwiększona powierzchnia osteoidu i zwiększona grubość szwu osteoidu.¹⁸ Przy stosowaniu kryteriów kinetycznych do diagnozy osteomalacji, sugeruje się, że średnia szerokość szwu osteoidu większa niż 15 μm i czas opóźnienia mineralizacji większy niż 100 dni są odpowiednimi kryteriami diagnostycznymi.¹⁹

Mechanizm wadliwej mineralizacji nie jest taki sam we wszystkich zaburzeniach związanych z osteomalacją i krzywicą, a wskaźniki biochemiczne, takie jak poziom wapnia i fosforu w surowicy, również się różnią.²⁰ Dlatego dokładna diagnoza jest kluczowa dla właściwego leczenia i prognozowania wyniku.

Szczególne przypadki kliniczne

Najcięższą manifestacją u płodu jest krzywica wrodzona, która jest bardzo rzadka, ale znana.²¹
U niemowląt i małych dzieci, szczególnie w przypadku ciężkiej, klasycznej krzywicy, często występuje apatia i drażliwość.²²
Osłabienie mięśniowe w osteomalacji może być związane z hipofosfatemią, choć molekularna podstawa tego procesu pozostaje niewyjaśniona, bez obserwowanych różnic w względnych stężeniach fosfokreatyny mięśni szkieletowych, adenozynotrifosforanu lub fosforanu nieorganicznego szacowanych za pomocą spektroskopii rezonansu magnetycznego fosforu.²³

²⁴²⁵

Podsumowanie rokowania

Krzywica i osteomalacja są zaburzeniami, które przy odpowiednim rozpoznaniu i leczeniu mają zazwyczaj dobre rokowanie. Kluczowe jest wczesne wykrycie i rozpoczęcie leczenia, co pozwala zapobiec długotrwałym deformacjom i powikłaniom. W przypadku prostego niedoboru witaminy D, suplementacja i zwiększona ekspozycja na światło słoneczne mogą prowadzić do znaczącej poprawy w ciągu kilku tygodni do miesięcy.²⁶ Jednak w przypadkach bardziej złożonych, szczególnie tych związanych z chorobami podstawowymi, leczenie musi być dostosowane do indywidualnych potrzeb pacjenta, a całkowite wyleczenie może zająć dłuższy czas.²⁷

Kolejne rozdziały

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Materiały źródłowe

#1 Vitamin D Deficiency including Osteomalacia and Rickets
https://patient.info/doctor/vitamin-d-deficiency-including-osteomalacia-and-rickets-pro
Prognosis1 2 […] This depends on the underlying cause but the outcome of treatment of vitamin D deficiency is generally very good. […] Treatment of simple deficiency with vitamin D replacement and/or sunlight and correction of predisposing factors should lead to dramatic improvements. […] Rickets and osteomalacia should respond rapidly to vitamin D. Increased mobility with increase in muscle strength may be the first clinical response but there may be a temporary increase in bone pain. […] Some groups (eg, those in long-term institutional care) may require long-term maintenance therapy. […] As long as there is no specific resistance to treatment then bone healing often begins within a few weeks of starting treatment and complete healing within six months. […] Following treatment for vitamin D deficiency or insufficiency, lifestyle changes and vitamin D supplementation are likely to be needed long-term to maintain optimum vitamin D levels.
#2
https://step2.medbullets.com/orthopedics/120527/rickets–osteomalacia
Prognosis Depends on the etiology.
#3 Osteomalacia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK551616/
Osteomalacia is a preventable metabolic bone disorder. Most cases are related to vitamin D deficiency, so they can usually be treated appropriately and even considered cured. If other clinical factors have contributed to the development of osteomalacia, then treatment will need to be tailored and adjusted as necessary depending on the other findings. […] Once identified and an appropriate treatment plan is in place, laboratory values may begin to normalize within weeks of initiation. Symptom improvement is also appreciable in a similar period. Patients will require interval lab monitoring after starting therapy. Overall, complete healing of osteomalacia may vary and can take many months to over a year, depending on the initial cause.
#4 Osteomalacia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK551616/
Osteomalacia is a preventable metabolic bone disorder. Most cases are related to vitamin D deficiency, so they can usually be treated appropriately and even considered cured. If other clinical factors have contributed to the development of osteomalacia, then treatment will need to be tailored and adjusted as necessary depending on the other findings. […] Once identified and an appropriate treatment plan is in place, laboratory values may begin to normalize within weeks of initiation. Symptom improvement is also appreciable in a similar period. Patients will require interval lab monitoring after starting therapy. Overall, complete healing of osteomalacia may vary and can take many months to over a year, depending on the initial cause.
#5 Vitamin D Deficiency including Osteomalacia and Rickets
https://patient.info/doctor/vitamin-d-deficiency-including-osteomalacia-and-rickets-pro
Prognosis1 2 […] This depends on the underlying cause but the outcome of treatment of vitamin D deficiency is generally very good. […] Treatment of simple deficiency with vitamin D replacement and/or sunlight and correction of predisposing factors should lead to dramatic improvements. […] Rickets and osteomalacia should respond rapidly to vitamin D. Increased mobility with increase in muscle strength may be the first clinical response but there may be a temporary increase in bone pain. […] Some groups (eg, those in long-term institutional care) may require long-term maintenance therapy. […] As long as there is no specific resistance to treatment then bone healing often begins within a few weeks of starting treatment and complete healing within six months. […] Following treatment for vitamin D deficiency or insufficiency, lifestyle changes and vitamin D supplementation are likely to be needed long-term to maintain optimum vitamin D levels.
#6 Osteomalacia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK551616/
Osteomalacia is a preventable metabolic bone disorder. Most cases are related to vitamin D deficiency, so they can usually be treated appropriately and even considered cured. If other clinical factors have contributed to the development of osteomalacia, then treatment will need to be tailored and adjusted as necessary depending on the other findings. […] Once identified and an appropriate treatment plan is in place, laboratory values may begin to normalize within weeks of initiation. Symptom improvement is also appreciable in a similar period. Patients will require interval lab monitoring after starting therapy. Overall, complete healing of osteomalacia may vary and can take many months to over a year, depending on the initial cause.
#7 Vitamin D Deficiency including Osteomalacia and Rickets
https://patient.info/doctor/vitamin-d-deficiency-including-osteomalacia-and-rickets-pro
Prognosis1 2 […] This depends on the underlying cause but the outcome of treatment of vitamin D deficiency is generally very good. […] Treatment of simple deficiency with vitamin D replacement and/or sunlight and correction of predisposing factors should lead to dramatic improvements. […] Rickets and osteomalacia should respond rapidly to vitamin D. Increased mobility with increase in muscle strength may be the first clinical response but there may be a temporary increase in bone pain. […] Some groups (eg, those in long-term institutional care) may require long-term maintenance therapy. […] As long as there is no specific resistance to treatment then bone healing often begins within a few weeks of starting treatment and complete healing within six months. […] Following treatment for vitamin D deficiency or insufficiency, lifestyle changes and vitamin D supplementation are likely to be needed long-term to maintain optimum vitamin D levels.
#8 Vitamin D Deficiency including Osteomalacia and Rickets
https://patient.info/doctor/vitamin-d-deficiency-including-osteomalacia-and-rickets-pro
Prognosis1 2 […] This depends on the underlying cause but the outcome of treatment of vitamin D deficiency is generally very good. […] Treatment of simple deficiency with vitamin D replacement and/or sunlight and correction of predisposing factors should lead to dramatic improvements. […] Rickets and osteomalacia should respond rapidly to vitamin D. Increased mobility with increase in muscle strength may be the first clinical response but there may be a temporary increase in bone pain. […] Some groups (eg, those in long-term institutional care) may require long-term maintenance therapy. […] As long as there is no specific resistance to treatment then bone healing often begins within a few weeks of starting treatment and complete healing within six months. […] Following treatment for vitamin D deficiency or insufficiency, lifestyle changes and vitamin D supplementation are likely to be needed long-term to maintain optimum vitamin D levels.
#9 Nutritional rickets & osteomalacia: A practical approach to management
https://pmc.ncbi.nlm.nih.gov/articles/PMC8061584/
Defective mineralization of the growth plate and preformed osteoid result in rickets and osteomalacia, respectively. […] Nutritional rickets can have devastating health consequences beyond bony deformities and include life-threatening hypocalcaemic complications of seizures and, in infancy, heart failure due to dilated cardiomyopathy. […] In adults or adolescents with closed growth plates, osteomalacia presents with non-specific symptoms (fatigue, malaise and muscle weakness) and abnormal blood biochemistry, but only in extreme cases, it is associated with radiographic findings of Looser’s zone fractures. […] Ultimately, when the compensatory mechanism is exhausted, serum calcium will drop below the normal range, giving rise to hypocalcaemic complications such as seizures, tetany and heart failure due to dilated cardiomyopathy in infants.
#10 Nutritional rickets & osteomalacia: A practical approach to management
https://pmc.ncbi.nlm.nih.gov/articles/PMC8061584/
The clinical features of rickets and osteomalacia depend largely on the age of presentation and also the severity and duration of deficiency. […] The most severe manifestation in the foetus is congenital rickets which is very rare but not unheard of. […] There is absolutely no role for phosphate supplements in the treatment of nutritional rickets; in fact, giving phosphate worsens secondary hyperparathyroidism. […] Reversal of secondary hyperparathyroidism with vitamin D-calcium supplementation improves serum phosphate levels. […] Life-threatening complications of nutritional rickets are entirely preventable through supplementation of high risk groups, especially pregnant women and infants in the short term and food fortification strategies in the long term.
#11 Nutritional rickets & osteomalacia: A practical approach to management
https://pmc.ncbi.nlm.nih.gov/articles/PMC8061584/
Defective mineralization of the growth plate and preformed osteoid result in rickets and osteomalacia, respectively. […] Nutritional rickets can have devastating health consequences beyond bony deformities and include life-threatening hypocalcaemic complications of seizures and, in infancy, heart failure due to dilated cardiomyopathy. […] In adults or adolescents with closed growth plates, osteomalacia presents with non-specific symptoms (fatigue, malaise and muscle weakness) and abnormal blood biochemistry, but only in extreme cases, it is associated with radiographic findings of Looser’s zone fractures. […] Ultimately, when the compensatory mechanism is exhausted, serum calcium will drop below the normal range, giving rise to hypocalcaemic complications such as seizures, tetany and heart failure due to dilated cardiomyopathy in infants.
#12 Disorders Of Calcification: Osteomalacia and Rickets | Clinical Gate
https://clinicalgate.com/disorders-of-calcification-osteomalacia-and-rickets/
The diagnosis of osteomalacia must include evidence of an absolute increase in the total osteoid volume and an increased number of osteoid lamellae. […] In infants and young children, especially in severe, classic rickets, listlessness and irritability are common. […] In contrast, osteomalacia in adults may be difficult to detect on clinical grounds alone. […] The molecular basis remains elusive, with no difference observed in the relative concentrations of skeletal muscle phosphocreatine, adenosine triphosphate, or inorganic phosphate estimated by phosphorus nuclear magnetic resonance spectroscopy. […] The role of hypophosphatemia per se in muscular weakness is discussed in Chapter 6.
#13 Vitamin D Deficiency including Osteomalacia and Rickets
https://patient.info/doctor/vitamin-d-deficiency-including-osteomalacia-and-rickets-pro
Prognosis1 2 […] This depends on the underlying cause but the outcome of treatment of vitamin D deficiency is generally very good. […] Treatment of simple deficiency with vitamin D replacement and/or sunlight and correction of predisposing factors should lead to dramatic improvements. […] Rickets and osteomalacia should respond rapidly to vitamin D. Increased mobility with increase in muscle strength may be the first clinical response but there may be a temporary increase in bone pain. […] Some groups (eg, those in long-term institutional care) may require long-term maintenance therapy. […] As long as there is no specific resistance to treatment then bone healing often begins within a few weeks of starting treatment and complete healing within six months. […] Following treatment for vitamin D deficiency or insufficiency, lifestyle changes and vitamin D supplementation are likely to be needed long-term to maintain optimum vitamin D levels.
#14 Nutritional rickets & osteomalacia: A practical approach to management
https://pmc.ncbi.nlm.nih.gov/articles/PMC8061584/
The clinical features of rickets and osteomalacia depend largely on the age of presentation and also the severity and duration of deficiency. […] The most severe manifestation in the foetus is congenital rickets which is very rare but not unheard of. […] There is absolutely no role for phosphate supplements in the treatment of nutritional rickets; in fact, giving phosphate worsens secondary hyperparathyroidism. […] Reversal of secondary hyperparathyroidism with vitamin D-calcium supplementation improves serum phosphate levels. […] Life-threatening complications of nutritional rickets are entirely preventable through supplementation of high risk groups, especially pregnant women and infants in the short term and food fortification strategies in the long term.
#15 Vitamin D Deficiency including Osteomalacia and Rickets
https://patient.info/doctor/vitamin-d-deficiency-including-osteomalacia-and-rickets-pro
Prognosis1 2 […] This depends on the underlying cause but the outcome of treatment of vitamin D deficiency is generally very good. […] Treatment of simple deficiency with vitamin D replacement and/or sunlight and correction of predisposing factors should lead to dramatic improvements. […] Rickets and osteomalacia should respond rapidly to vitamin D. Increased mobility with increase in muscle strength may be the first clinical response but there may be a temporary increase in bone pain. […] Some groups (eg, those in long-term institutional care) may require long-term maintenance therapy. […] As long as there is no specific resistance to treatment then bone healing often begins within a few weeks of starting treatment and complete healing within six months. […] Following treatment for vitamin D deficiency or insufficiency, lifestyle changes and vitamin D supplementation are likely to be needed long-term to maintain optimum vitamin D levels.
#16 Vitamin D Deficiency including Osteomalacia and Rickets
https://patient.info/doctor/vitamin-d-deficiency-including-osteomalacia-and-rickets-pro
Prognosis1 2 […] This depends on the underlying cause but the outcome of treatment of vitamin D deficiency is generally very good. […] Treatment of simple deficiency with vitamin D replacement and/or sunlight and correction of predisposing factors should lead to dramatic improvements. […] Rickets and osteomalacia should respond rapidly to vitamin D. Increased mobility with increase in muscle strength may be the first clinical response but there may be a temporary increase in bone pain. […] Some groups (eg, those in long-term institutional care) may require long-term maintenance therapy. […] As long as there is no specific resistance to treatment then bone healing often begins within a few weeks of starting treatment and complete healing within six months. […] Following treatment for vitamin D deficiency or insufficiency, lifestyle changes and vitamin D supplementation are likely to be needed long-term to maintain optimum vitamin D levels.
#17 Disorders Of Calcification: Osteomalacia and Rickets | Clinical Gate
https://clinicalgate.com/disorders-of-calcification-osteomalacia-and-rickets/
The diagnosis of osteomalacia must include evidence of an absolute increase in the total osteoid volume and an increased number of osteoid lamellae. […] In infants and young children, especially in severe, classic rickets, listlessness and irritability are common. […] In contrast, osteomalacia in adults may be difficult to detect on clinical grounds alone. […] The molecular basis remains elusive, with no difference observed in the relative concentrations of skeletal muscle phosphocreatine, adenosine triphosphate, or inorganic phosphate estimated by phosphorus nuclear magnetic resonance spectroscopy. […] The role of hypophosphatemia per se in muscular weakness is discussed in Chapter 6.
#18 Disorders Of Calcification: Osteomalacia and Rickets | Clinical Gate
https://clinicalgate.com/disorders-of-calcification-osteomalacia-and-rickets/
Osteomalacia and rickets are disorders of mineralization. Osteomalacia is a failure to mineralize the newly formed organic matrix (osteoid) of bone. In rickets, a disease of children, the growth plate at the epiphysis is involved in a process that is characterized by delay in the maturation of chondrocytes in the growth plate and disorganization of these chondrocytes, resulting in expansion of the growth plate. […] The mechanism of defective mineralization is not the same in all disorders associated with osteomalacia and rickets, and biochemical indices such as serum levels of calcium and phosphorus also differ. […] The major histologic criteria for the diagnosis of osteomalacia are the increased osteoid surface and the increased thickness of the osteoid seam. […] In applying kinetic criteria to the diagnosis of osteomalacia, it has been suggested that a mean osteoid seam width greater than 15 m and a mineralization lag time greater than 100 days are appropriate diagnostic criteria.
#19 Disorders Of Calcification: Osteomalacia and Rickets | Clinical Gate
https://clinicalgate.com/disorders-of-calcification-osteomalacia-and-rickets/
Osteomalacia and rickets are disorders of mineralization. Osteomalacia is a failure to mineralize the newly formed organic matrix (osteoid) of bone. In rickets, a disease of children, the growth plate at the epiphysis is involved in a process that is characterized by delay in the maturation of chondrocytes in the growth plate and disorganization of these chondrocytes, resulting in expansion of the growth plate. […] The mechanism of defective mineralization is not the same in all disorders associated with osteomalacia and rickets, and biochemical indices such as serum levels of calcium and phosphorus also differ. […] The major histologic criteria for the diagnosis of osteomalacia are the increased osteoid surface and the increased thickness of the osteoid seam. […] In applying kinetic criteria to the diagnosis of osteomalacia, it has been suggested that a mean osteoid seam width greater than 15 m and a mineralization lag time greater than 100 days are appropriate diagnostic criteria.
#20 Disorders Of Calcification: Osteomalacia and Rickets | Clinical Gate
https://clinicalgate.com/disorders-of-calcification-osteomalacia-and-rickets/
Osteomalacia and rickets are disorders of mineralization. Osteomalacia is a failure to mineralize the newly formed organic matrix (osteoid) of bone. In rickets, a disease of children, the growth plate at the epiphysis is involved in a process that is characterized by delay in the maturation of chondrocytes in the growth plate and disorganization of these chondrocytes, resulting in expansion of the growth plate. […] The mechanism of defective mineralization is not the same in all disorders associated with osteomalacia and rickets, and biochemical indices such as serum levels of calcium and phosphorus also differ. […] The major histologic criteria for the diagnosis of osteomalacia are the increased osteoid surface and the increased thickness of the osteoid seam. […] In applying kinetic criteria to the diagnosis of osteomalacia, it has been suggested that a mean osteoid seam width greater than 15 m and a mineralization lag time greater than 100 days are appropriate diagnostic criteria.
#21 Nutritional rickets & osteomalacia: A practical approach to management
https://pmc.ncbi.nlm.nih.gov/articles/PMC8061584/
The clinical features of rickets and osteomalacia depend largely on the age of presentation and also the severity and duration of deficiency. […] The most severe manifestation in the foetus is congenital rickets which is very rare but not unheard of. […] There is absolutely no role for phosphate supplements in the treatment of nutritional rickets; in fact, giving phosphate worsens secondary hyperparathyroidism. […] Reversal of secondary hyperparathyroidism with vitamin D-calcium supplementation improves serum phosphate levels. […] Life-threatening complications of nutritional rickets are entirely preventable through supplementation of high risk groups, especially pregnant women and infants in the short term and food fortification strategies in the long term.
#22 Disorders Of Calcification: Osteomalacia and Rickets | Clinical Gate
https://clinicalgate.com/disorders-of-calcification-osteomalacia-and-rickets/
The diagnosis of osteomalacia must include evidence of an absolute increase in the total osteoid volume and an increased number of osteoid lamellae. […] In infants and young children, especially in severe, classic rickets, listlessness and irritability are common. […] In contrast, osteomalacia in adults may be difficult to detect on clinical grounds alone. […] The molecular basis remains elusive, with no difference observed in the relative concentrations of skeletal muscle phosphocreatine, adenosine triphosphate, or inorganic phosphate estimated by phosphorus nuclear magnetic resonance spectroscopy. […] The role of hypophosphatemia per se in muscular weakness is discussed in Chapter 6.
#23 Disorders Of Calcification: Osteomalacia and Rickets | Clinical Gate
https://clinicalgate.com/disorders-of-calcification-osteomalacia-and-rickets/
The diagnosis of osteomalacia must include evidence of an absolute increase in the total osteoid volume and an increased number of osteoid lamellae. […] In infants and young children, especially in severe, classic rickets, listlessness and irritability are common. […] In contrast, osteomalacia in adults may be difficult to detect on clinical grounds alone. […] The molecular basis remains elusive, with no difference observed in the relative concentrations of skeletal muscle phosphocreatine, adenosine triphosphate, or inorganic phosphate estimated by phosphorus nuclear magnetic resonance spectroscopy. […] The role of hypophosphatemia per se in muscular weakness is discussed in Chapter 6.
#24 Nutritional rickets & osteomalacia: A practical approach to management
https://pmc.ncbi.nlm.nih.gov/articles/PMC8061584/
The clinical features of rickets and osteomalacia depend largely on the age of presentation and also the severity and duration of deficiency. […] The most severe manifestation in the foetus is congenital rickets which is very rare but not unheard of. […] There is absolutely no role for phosphate supplements in the treatment of nutritional rickets; in fact, giving phosphate worsens secondary hyperparathyroidism. […] Reversal of secondary hyperparathyroidism with vitamin D-calcium supplementation improves serum phosphate levels. […] Life-threatening complications of nutritional rickets are entirely preventable through supplementation of high risk groups, especially pregnant women and infants in the short term and food fortification strategies in the long term.
#25 Disorders Of Calcification: Osteomalacia and Rickets | Clinical Gate
https://clinicalgate.com/disorders-of-calcification-osteomalacia-and-rickets/
The diagnosis of osteomalacia must include evidence of an absolute increase in the total osteoid volume and an increased number of osteoid lamellae. […] In infants and young children, especially in severe, classic rickets, listlessness and irritability are common. […] In contrast, osteomalacia in adults may be difficult to detect on clinical grounds alone. […] The molecular basis remains elusive, with no difference observed in the relative concentrations of skeletal muscle phosphocreatine, adenosine triphosphate, or inorganic phosphate estimated by phosphorus nuclear magnetic resonance spectroscopy. […] The role of hypophosphatemia per se in muscular weakness is discussed in Chapter 6.
#26 Vitamin D Deficiency including Osteomalacia and Rickets
https://patient.info/doctor/vitamin-d-deficiency-including-osteomalacia-and-rickets-pro
Prognosis1 2 […] This depends on the underlying cause but the outcome of treatment of vitamin D deficiency is generally very good. […] Treatment of simple deficiency with vitamin D replacement and/or sunlight and correction of predisposing factors should lead to dramatic improvements. […] Rickets and osteomalacia should respond rapidly to vitamin D. Increased mobility with increase in muscle strength may be the first clinical response but there may be a temporary increase in bone pain. […] Some groups (eg, those in long-term institutional care) may require long-term maintenance therapy. […] As long as there is no specific resistance to treatment then bone healing often begins within a few weeks of starting treatment and complete healing within six months. […] Following treatment for vitamin D deficiency or insufficiency, lifestyle changes and vitamin D supplementation are likely to be needed long-term to maintain optimum vitamin D levels.
#27 Osteomalacia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK551616/
Osteomalacia is a preventable metabolic bone disorder. Most cases are related to vitamin D deficiency, so they can usually be treated appropriately and even considered cured. If other clinical factors have contributed to the development of osteomalacia, then treatment will need to be tailored and adjusted as necessary depending on the other findings. […] Once identified and an appropriate treatment plan is in place, laboratory values may begin to normalize within weeks of initiation. Symptom improvement is also appreciable in a similar period. Patients will require interval lab monitoring after starting therapy. Overall, complete healing of osteomalacia may vary and can take many months to over a year, depending on the initial cause.