Osteomalacia

The clinical picture and over. The disease develops gradually and is distinguished by a prolonged period. There are cases of rapid, progressive course with legal outcome.
Major symptoms are vague pain in the back and thighs, at least in the shoulder and chest, continuing nature that occur even at rest. The sensitivity of the bones under pressure appears very early. Pain comes as a side compression scallops Ilium, and at the termination of the compression of the pelvis. Early characteristic is also contracture of adduction is difficult to raise and spread his legs (Fig. 3). Quite early appear paresthesias. At the beginning of the diseases of the bones have only high fragility. With the development of the disease, pain in the bones stronger, movements become quite impossible appear deformation of the skeleton. As far advanced disease of the bone acquire waxy flexibility. In severe forms of the disease can be mental disorders, gastrointestinal tract and cardiovascular system.
The clinical picture of puerperal form - see below Osteomalacia in pregnant women.
The diagnosis of primary forms osteomalacia in the absence of the expressed clinical manifestations represents a significant challenge. With the development of the disease diagnostics facilitates kind of lesion localization, characteristic of each of the forms osteomalacia (Fig. 4 and 5).

Fig. 3. Contracture of adduction with osteomalacia.
Fig. 4. The woman is 54 years old, ill disorder 4 years (climacteric form).
Fig. 5. The patient severe form osteomalacia (on Bummy).

When children and youth forms osteomalacia deformation are mainly limb bones. Already quite early, you can find starting a funnel chest deformation or a slight curvature of legs: when closed feet away a few inches knee joints, and when closed her feet.
When expressed puerperal form osteomalacia entrance to the pelvis acquires the characteristic form "a card of the heart."
When menopausal O. noteworthy kyphosis, lumbar region seems to be shortened, and in advanced cases really are shortening the length of the body. As shortened the trunk, we get a picture "seated dwarf". Only in rare cases it comes to such distortions of the skeleton, which in combination with painful bone lead to complete immobility.
Senile O. changes pelvis recede into the background, but more often than menopausal form, there are multiple fractures. While in the lungs cases, the walk is not broken, for cases of moderate typical gait waddled.
There is also gait small steps, as in Parkinson's disease. Particularly difficult walking upstairs.
From laboratory data greatest value has increased alkaline phosphatase in the blood, indicating increased activity of osteoblasts. The content of calcium and phosphorus, as a rule, slightly reduced. In unclear cases should resort to the bone biopsy scallop Ilium. Finally, diagnostic purposes can be used the results of a trial of therapy with vitamin D for 3-6 weeks.
X-ray diagnostics osteomalacia. The first x-ray characteristic osteomalacia is common osteoporosis (see), the degree of which is the more significant, the longer and more intensive disease. In the future, is typical for osteomalacia arched plastic deformation of the bones. The presence osteodes tissue promotes greater severity of osteoporosis and creates in the places of its accumulation zone of enlightenment with violation of the clear contours of compact bone substance and structure of the spongy bone tissue. When a cluster Stevenage substances under the periosteum and during gaverova channels, except for vague contours of a bone, is defined layered character of the pattern of cortical layer. A significant degree of osteoporosis is characterized by the almost complete disappearance of the rungs of the spongy bone. Thus bone marrow space considerably expanded, and cortical layer dramatically thinned.
The value of radiodiagnosis early detection of the disease is low (C. A. Reinberg)since early sign of osteomalacia - osteoporosis - occur with many diseases. However, in early cases O. systemic osteoporosis, despite primary defeat of one or another part of the skeleton becomes important differential diagnostic value.
X-ray examination makes it relatively easy to distinguish from Acting inflammatory and neoplastic diseases. From a systemic skeletal diseases O. characteristic distinguishes localization bone changes: when youth form - this defeat bones, puerperal - pelvic bones, senile - spine.
Unlike imperfect bone formation (see imperfect Osteogenesis), deformation of bones at osteomalacia has not corner and a bow-shaped form. When illness of Recklinghausen observed cellular racemose enlightenment and thickening of the bones, which does not happen when Acting, and Looser zone of perestroika (see), rather characteristic for Acting, in the case of Recklinghausen occur much less frequently. The main distinguishing feature of youth Acting from the late rickets is the absence O. violations encontrarnos of ossification. Cm. also Osteodysplastic, Osteodystrophy.
Forecast when osteomalacia heavy. Death comes not so much from the basic disease, but from complications of internal organs, as well as from opportunistic diseases.
Prevention and treatment. The main task of prevention and treatment - improvement of social and hygienic living conditions. Need a rational and balanced diet, rich in vitamins (especially vitamin D), salts of calcium and phosphate.