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RicketsRickets
OsteomalaciaOsteomalacia
Defective Mineralization of CartilageDefective Mineralization of Cartilage Growth PlateGrowth Plate
Defective Mineralization of Bone Defective Mineralization of Bone MatrixMatrix
7 dehydrocholesterol
Pre- vitamin D 3
Vitamin D 3
Dietary source :
Vit D2 (ergocalciferol)
Vit D3 (cholecalciferol)
Vitamin D
Function of vit D
Lack of VIT-D
Intestinal Ca , p absorption
Hypocalcemia
PTH secretion
Ca released from bone
Ca : NL
P:
P urinary clearance
BONE Demineralization
P:
Classification of Rickets & OsteomalaciaClassification of Rickets & Osteomalacia
• Vit D deficiency• GI disorder• Disorder of vit D metabolism• Acidosis• CRF• Generalized renal tubular disorder• Primary Mineralization defect• Defective Matrix synthetase• Others
Clinical Manifestation in RicketsClinical Manifestation in Rickets
o Skull
o Swelling Epiphysis at wristo Richet,s rossaryo Harrison,s Sulcuso Bow or Knock Kneeo Wind Swept Lego Ricket , s Myopathyo Pelvic Deformity
CraniotabesCranial Vault
SKULL
• Parietal flattening
• Frontal bossing
• Softening of calvariae
• Widening of suture
Prominance of costocondral junction ( rachitic rosary )
Indentation of lower ribs at the site of attachment to diaphragm
( harrison’s groove )
RicketsRicketsLeg bowingLeg bowing
Hereditary resistance to vit D
Clinical Manifestation in OsteomalaciaClinical Manifestation in Osteomalacia
o generalized Bone Pain
o Localized Bone Pain in Groino Osteomalacia Myopathyo Secondary Osteoarthritis o Marked enthesopathy o waddling gait
SpineRibesPelvis
Sacroiliac Wrist Knee Facet Joints
Radiology Of osteomalacia or ricketsRadiology Of osteomalacia or rickets
• Craniotabes• Widening , cupping and ragging of Growth plate• Bowing of Leg• pelvic Abnormalities• Kyphoscoliosis• Bone fractures ( spine )• Looser Zone• protruacetabuli
Widening
Bowing & FractureBowing & Fracture
Fraying& WideningFraying& Widening
Hypophosphatemic osteomalacia
Fraying
Loozer ZoneLoozer Zone
Loozer ZoneLoozer Zone
Loozer ZoneLoozer Zone
Pseudofracture
OsteomalaciaOsteomalacia
Biochemical Change in OsteomalaciaBiochemical Change in Osteomalacia
1- ca P = Nl Alk ph1- ca P = Nl Alk ph2- ca = Nl P Alk ph2- ca = Nl P Alk ph3- ca P Alk ph3- ca P Alk ph
24 h Urinary ca < 100 mg / 24 h24 h Urinary Hydroxyproline Excretion
Work up for OsteomalaciaWork up for Osteomalacia
Ca , P , Alk ph Ca , P , Alk ph 24 h urinary Ca24 h urinary Ca 25 ( OH ) D25 ( OH ) D 1 , 25 ( OH ) D1 , 25 ( OH ) D PTHPTH Bone BiopsyBone Biopsy
Treatment of osteomalacaTreatment of osteomalaca
• Sun light or Dietary • Children with tetany• Malabsorption
• Anticonvulsant • RTA
• Nephrotic Syn• CRF(
( Vit D 800 – 4000 IU / d ) ( Vit D 800 – 4000 IU / d ) ( Ca + Large dose Vit D )
( Vit D 50000- 100000 IU / d orμ 0/5 – 1 Calcitriol + 15 g / d calcium lactate or 4g/d calcium carbonate )
( Vit D 1000 IU / d ) ( Inorganic Phosphate 1- 3/6 g / d + μ 0/5 – 2 Calcitriol / d )
( Vit D 800-1000 IU / d )μ 0/5 – 1 Calcitriol / d μ1-2/5 Calcitriol 3 / W in dialysed patient)