RicketsOsteomalacia Defective Mineralization of Cartilage Growth Plate Growth Plate Defective...
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Transcript of RicketsOsteomalacia Defective Mineralization of Cartilage Growth Plate Growth Plate Defective...
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)