What is osteomalacia (bone softening)?

Osteomalacia, which means bone softening, is a type of disease in which there are structural deformations and deformations in the bone tissue that usually occur due to vitamin D deficiency. This disease, which can affect individuals of all ages, is generally observed more frequently in elderly individuals. If it is seen in childhood, it can reach more serious dimensions with age, as it will cause bending and twisting, especially in long bones, along with growth and development. If it is noticed in the early period and treatment is initiated, it is likely to be prevented before permanent damage occurs, especially in childhood patients. In order to be protected from the disease, a healthy and balanced diet should be taken care of at all ages, and enough calcium and vitamin D sources should be included in the diet.



What is osteomalacia?

Osteomalacia is a bone softening disease that usually occurs due to vitamin D deficiency. Under normal conditions, bone tissue consists of active and living cells that continue their life in a cycle with continuous construction and destruction activities. Bone tissue consists mainly of a shell tissue (cortex) consisting of calcium and phosphorus minerals, and an internal network of collagen fibers, also known as matrix, a softer tissue. During the formation of the bone, the fibers in it are covered with minerals and the strength of the bone depends on the amount of minerals that cover these tissues. As the amount of mineral decreases, the bone begins to soften and weaken. In osteomalacia patients, the bones soften due to the unmineralised collagen fibers in the bones, and accordingly, they can bend, crack, and cause severe pain. In the case of osteomalacia during growth in children and young adults, the problem of bending and distortion may occur, especially in the leg bones exposed to weight. The formation of fractures and cracks is common in the elderly.


What are the symptoms of osteomalacia?

Osteomalacia does not cause any symptoms in the early stages. Since the slight softening of the bones during this period does not cause curvature, bending, fracture, cracking and related pain, it can only be detected by x-ray examination or different medical imaging techniques and diagnostic tests. However, as osteomalacia progresses and increases its severity, bone pain and muscle weakness problems begin to occur. Dull pain occurs especially in the waist, pelvis, legs, hip and rib bones. Pain may become more severe at night or when pressure is placed on the bones. Due to the reduced muscle tone, even short walks can be very tiring for osteomalacia patients. Apart from these, the most common symptoms of osteomalacia are:

• Easy breaking and cracking of bones
• Constant feeling of tiredness
• Bone pain
• Difficulty doing activities such as sitting, walking, and climbing stairs
• Weakness of arm and leg muscles

Apart from these, due to the presence of a very low amount of calcium minerals in the blood, arrhythmia in the heart, numbness in the mouth and arms and legs, spasms (cramps) in the hands and feet can be seen in patients with osteomalacia. All of these symptoms indicate severe calcium and vitamin D deficiency, and all individuals experiencing any one or more of the symptoms should seek medical attention immediately.


What are the causes of osteomalacia?

Osteomalacia disease can develop due to any disorder in the maturation process of the bones. Adequate intake of calcium and phosphorus minerals with foods is required for the production of strong bone tissues. For this, a nutrition program consisting of healthy foods containing all nutrients in sufficient and balanced amounts should be made into a habit. Osteomalacia disease may develop in cases where these minerals are not taken in enough by diet or cannot be absorbed or used by the body despite the diet due to some reasons. The most common cause of the disease is vitamin D deficiency. Vitamin D is taken into the body with foods and transformed into a form that the body can use with the help of sunlight. The most common cause of osteomalacia in the world is insufficient dietary vitamin D intake or living indoors or in areas with little sunlight. A second reason is that the absorption of vitamin D and minerals such as calcium and phosphorus is insufficient due to bariatric surgery operations (stomach reduction surgery, etc.) or intestinal operations performed for various reasons. With celiac disease, which develops in the form of an autoimmune response of the body against the protein called gluten found in barley, wheat and rye, and the metabolism of calcium, phosphorus and vitamin D is impaired in kidney and liver diseases, the possibility of developing osteomalacia greatly increases. Some medicines that are used continuously may also predispose to the formation of this disease by affecting the absorption of vitamins and minerals. In addition to all these, advanced age is among the main risk factors for osteomalacia, and much more attention should be paid to meeting the vitamin and mineral needs from adulthood, when bone destruction prevails over bone formation.



How is osteomalacia diagnosed?

Unfortunately, osteomalacia goes unnoticed until the symptoms get worse. For this reason, it is beneficial to check the vitamin and mineral levels at regular intervals. To diagnose the disease, the levels of vitamin D, phosphorus and calcium in the blood can be examined with a simple blood test. In addition, Alkaline Phosphatase (ALP), a type of enzyme produced by osteoblasts, which are bone-producing cells, and parathyroid hormone (PTH) produced by parathyroid hormone are often outside of normal ranges in osteomalacia patients. If an abnormality is detected in any or more of these parameters, the softening and density levels in the bone tissue can be determined using medical imaging techniques. As a result of all these studies, the treatment process should be started as soon as possible in patients diagnosed with bone softening. In patients diagnosed in the early stages, problems such as bending, cracking and fractures in the bones can be prevented, and the formation of permanent damage can be prevented to a great extent.



What is the treatment for osteomalacia?

Since the symptoms of osteomalacia are not very pronounced, the diagnosis of the disease is usually delayed. This causes a decrease in the success rate of treatment and irreversible damage to the bones. In order to prevent delay in diagnosis, vitamin and mineral levels should be investigated regularly in individuals living in closed environments for any reason or in geographical areas with insufficient number of sunny days. Likewise, bone scans should be done regularly starting from middle age. In cases of osteomalacia detected at an early stage, calcium, phosphorus and vitamin D supplements are generally sufficient for treatment. With the help of these supplements, most symptoms improve within a few months at the latest. Vitamin and mineral supplements given can be in the form of injections or oral medications. Vitamin supplements are usually given intravenously in patients with vitamin and mineral absorption disorders due to stomach and intestinal operations or digestive system diseases. In addition, a healthy and balanced nutrition program that is prepared specifically for the patient by the dietician and meets the vitamin and mineral requirements should be applied. In severe cases of osteomalacia, surgical operations may be required in some cases to repair cracks, fractures and structural deformations in the bones. In addition, dental practices should be used for the treatment of health problems in teeth.

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