- Osteomayaltion's symptoms
- Osteomayaltion's reasons
- Osteomayaltion's treatment
Osteomalacy (Latin osteomalacia from other - Greek - a bone + — softness — a softening of bones) — the general disease which is characterized by an insufficient mineralization of a bone tissue.
Osteomalacy is rickets of the adult. The disease is observed at women approximately by 10 times more often than at men. Depending on time of emergence distinguish 4 forms:
a) late rickets of the period of puberty;
b) puerperal osteomalacy (it is observed very seldom and mostly it is localized only in a backbone);
c) climacteric osteomalacy;
d) senile osteomalacy.
Besides, the excretory osteomalacy which is not depending on age at pathological release of calcium owing to long diseases of kidneys meets.
At all 4 forms of osteomalacy uncertain dorsodynias and hips can be the leading symptom, pains are more rare are felt in a shoulder and a thorax. At the beginning of a disease the noticeable deformations of a skeleton so characteristic of the expressed cases, no. Nevertheless at late rickets already early it is possible to find insignificant curvatures of legs: at close feet knee joints depart on several centimeters, and at close knees — feet (Wernly) or the beginning funneled deformation of a thorax. At climacteric osteomalacy the kyphosis especially attracts attention, the lumbar area seems shortened, and in far come cases shortening of length of a body really is observed. As only the trunk is exposed to shortening, there is a picture of the sedentary dwarf (contrary to a sedentary giant at a chondrodystrophia). Only in rare instances business reaches further curvatures of a skeleton which in combination with morbidity of bones lead to full loss of mobility.
At senile osteomalacy of change of a basin recede on a background, but it is considerable more often than at climacteric osteomalacy, quite often multiple fractures are observed. While in mild cases walking is not broken, gait a vperevalka is typical for moderately severe cases (alternate inclinations of an upper half of a body to the right and to the left). Also gait with small steps ("marche a petits pas"), as is observed at parkinsonism. Walking on a ladder and on steps (Wernly) is especially complicated. Sensitivity of bones with a pressure is expressed already very much early. Pains are caused as at a side prelum of combs of ileal bones, and at the termination of a prelum of the basin compressed on several millimeters. It is necessary to pay attention to a spasm of adductors of legs. A frequent epiphenomenon — the hidden tetany. In typical cases great diagnostic value belongs to a X-ray pattern.
Osteomalacy of bones is characterized by depletion by calcium salts, curvatures of bones and existence of zones of reorganization of Loozer (Milkman's syndrome).
The contour vagueness which can make an impression of indistinct installation of the device is typical. It is possible to speak in these cases about "Renoir aspect". Osteoporosis in itself, certainly, is not evidential for osteomalacy yet. At the same time decalcification is not always distinguished radiological.
From bone curvatures deformation of a basin in the form of "an ace of worms" which more is clearly expressed to a thicket on anatomic drug is especially characteristic of osteomalacy.
Zones of reorganization of Loozer, one may say, pathognomonic for osteomalacy which are characterized by indistinctly limited enlightenments of bone shadows in the form of strips, cracks or wedges are most often observed in branches of pubic bones, in a neck of a hip, tibial, humeral, small tibial bones and in edges.
From datas of laboratory the greatest diagnostic value has the increase in an alkaline phosphatase (normal 3 units) indicating the increased activity of osteoblasts. Content of calcium (it is normal of 9,5 — 11 mg of %) and phosphorus (inorganic phosphates — 2,7 — 3,7 mg of % are normal) is, as a rule, slightly lowered On Albright, decrease in content of salts of calcium and phosphoric acid is especially characteristic.
In not clear cases it is necessary to resort to a bone biopsy. The only absolutely reliable diagnostic character is detection of an ossiform border (Schiipbach, Wernly). The biopsy of a comb of a haunch bone can be carried out without any difficulties by any surgeon under local anesthesia
At last, with the diagnostic purpose also results of trial therapy can be used by vitamin D (ot 3 to 6 shock doses on 600000 PIECES in Solutio oleosa intramusculary within 3 — 6 weeks).
It can be caused by a lack of vitamin D, disturbance of its exchange, and also deficit macro - and microelements, caused by their increased filtering in kidneys or disturbance of absorption in intestines. At osteomalacy the total amount of bone substance increases, but its mineralization decreases.
Treatment, as a rule, conservative. It includes purpose of vitamin D, drugs of calcium, phosphorus, fortifying therapy, UF-radiation, remedial gymnastics and massage. When forming of the expressed deformations of extremities treatment operational in combination with a complex of the actions directed to normalization of mineral exchange. Deformation of pelvic bones at pregnancy is the indication to Cesarean section. When progressing an osteomalation in the period of a lactation pass to artificial feeding.
The forecast for life at timely treatment favorable.