Interdisciplinary Nursing, Radiologic, Health Information, and Nutritional Perspectives in the Assessment and Management of Osteomalacia
Abstract
Background: Osteomalacia is a metabolic bone disease characterized by defective bone mineralization, leading to softened bones and an increased risk of pain, deformity, and fracture. It is primarily caused by prolonged and severe vitamin D deficiency, which disrupts calcium and phosphate homeostasis. Other etiologies include malabsorption syndromes, chronic kidney or liver disease, certain medications, and hereditary phosphate-wasting disorders.
Aim: This article aims to provide a comprehensive, interdisciplinary review of the assessment and management of osteomalacia, integrating perspectives from nursing, radiology, health information, and nutrition to optimize patient diagnosis, treatment, and long-term care.
Methods: The review synthesizes current clinical knowledge, detailing the pathophysiology of vitamin D metabolism, the evaluation through biochemical testing (e.g., serum 25-hydroxyvitamin D, calcium, phosphate, alkaline phosphatase) and radiologic imaging (e.g., identification of Looser zones), and the principles of management.
Results: Diagnosis relies on a combination of clinical symptoms (e.g., bone pain, proximal muscle weakness), characteristic biochemical abnormalities, and radiographic findings. Treatment is centered on correcting the underlying cause and replenishing vitamin D and calcium stores through high-dose supplementation, followed by lifelong maintenance therapy. The successful management of this condition is highly dependent on a collaborative, interprofessional team.
Conclusion: Osteomalacia is a largely reversible disorder with a favorable prognosis when diagnosed and treated promptly. An interdisciplinary approach is crucial for accurate diagnosis, effective treatment, patient education, and prevention of long-term complications.
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References
Vaishya R, Vijay V, Agarwal AK, Jahangir J. Resurgence of vitamin D: Old wine in new bottle. J Clin Orthop Trauma. 2015 Sep;6(3):173-83.
Rokan Z, Kealey WD. Osteomalacia: a forgotten cause of fractures in the elderly. BMJ Case Rep. 2015 Feb 09;2015
Emini-Sadiku M, Morina-Kuqi N. Concealing Clothing Leading to Severe Vitamin D Deficiency, Osteomalacia and Muscle Weakness. Open Access Maced J Med Sci. 2019 Jul 15;7(13):2146-2149.
Cianferotti L. Osteomalacia Is Not a Single Disease. Int J Mol Sci. 2022 Nov 28;23(23)
Vilaca T, Velmurugan N, Smith C, Abrahamsen B, Eastell R. Osteomalacia as a Complication of Intravenous Iron Infusion: A Systematic Review of Case Reports. J Bone Miner Res. 2022 Jun;37(6):1188-1199.
Jan de Beur SM, Minisola S, Xia WB, Abrahamsen B, Body JJ, Brandi ML, Clifton-Bligh R, Collins M, Florenzano P, Houillier P, Imanishi Y, Imel EA, Khan AA, Zillikens MC, Fukumoto S. Global guidance for the recognition, diagnosis, and management of tumor-induced osteomalacia. J Intern Med. 2023 Mar;293(3):309-328.
Cianferotti L, Delli Poggi C, Bertoldo F, Caffarelli C, Crotti C, Gatti D, Giannini S, Gonnelli S, Mazzantini M, Ombretta V, Sella S, Setti A, Varenna M, Zucchi F, Brandi ML. Persistence and recurrence in tumor-induced osteomalacia: A systematic review of the literature and results from a national survey/case series. Endocrine. 2022 Jun;76(3):709-721.
Minisola S, Fukumoto S, Xia W, Corsi A, Colangelo L, Scillitani A, Pepe J, Cipriani C, Thakker RV. Tumor-induced Osteomalacia: A Comprehensive Review. Endocr Rev. 2023 Mar 04;44(2):323-353.
Rendina D, Abate V, Cacace G, D'Elia L, De Filippo G, Del Vecchio S, Galletti F, Cuocolo A, Strazzullo P. Tumor-induced Osteomalacia: A Systematic Review and Individual Patient's Data Analysis. J Clin Endocrinol Metab. 2022 Jul 14;107(8):e3428-e3436.
Brandi ML, Clunie GPR, Houillier P, Jan de Beur SM, Minisola S, Oheim R, Seefried L. Challenges in the management of tumor-induced osteomalacia (TIO). Bone. 2021 Nov;152:116064.
Minisola S, Colangelo L, Pepe J, Diacinti D, Cipriani C, Rao SD. Osteomalacia and Vitamin D Status: A Clinical Update 2020. JBMR Plus. 2021 Jan;5(1):e10447.
Khan MA, Dar HA, Baba MA, Shah AH, Singh B, Shiekh NA. Impact of Vitamin D Status in Chronic Liver Disease. J Clin Exp Hepatol. 2019 Sep-Oct;9(5):574-580.
Gou M, Ma Z. Osteomalacia, renal Fanconi syndrome, and bone tumor. J Int Med Res. 2018 Aug;46(8):3487-3490.
Liu S, Zhou X, Song A, Huo Z, Wang Y, Xia W, Liu Y. Successful treatment of tumor-induced osteomalacia causing by phosphaturic mesenchymal tumor of the foot. Medicine (Baltimore). 2019 Jul;98(27):e16296.
Rigante M, Loperfido A, Paludetti G. Oncogenic Osteomalacia with Elevated Fibroblast Growth Factor 23: A Rare Case of Paranasal Sinus Tumor Onset. Cureus. 2019 Jun 17;11(6):e4919.
Uday S, Högler W. Nutritional Rickets and Osteomalacia in the Twenty-first Century: Revised Concepts, Public Health, and Prevention Strategies. Curr Osteoporos Rep. 2017 Aug;15(4):293-302.
Uday S, Högler W. Nutritional rickets & osteomalacia: A practical approach to management. Indian J Med Res. 2020 Oct;152(4):356-367.
Arboleya L, Braña I, Pardo E, Loredo M, Queiro R. Osteomalacia in Adults: A Practical Insight for Clinicians. J Clin Med. 2023 Apr 05;12(7)
Rosen CJ. Clinical practice. Vitamin D insufficiency. N Engl J Med. 2011 Jan 20;364(3):248
Hill TR, Aspray TJ. The role of vitamin D in maintaining bone health in older people. Ther Adv Musculoskelet Dis. 2017 Apr;9(4):89-95.
Fukumoto S, Ozono K, Michigami T, Minagawa M, Okazaki R, Sugimoto T, Takeuchi Y, Matsumoto T. Pathogenesis and diagnostic criteria for rickets and osteomalacia--proposal by an expert panel supported by the Ministry of Health, Labour and Welfare, Japan, the Japanese Society for Bone and Mineral Research, and the Japan Endocrine Society. J Bone Miner Metab. 2015 Sep;33(5):467-73.
Uday S, Högler W. Spot the silent sufferers: A call for clinical diagnostic criteria for solar and nutritional osteomalacia. J Steroid Biochem Mol Biol. 2019 Apr;188:141-146.
Chang CY, Rosenthal DI, Mitchell DM, Handa A, Kattapuram SV, Huang AJ. Imaging Findings of Metabolic Bone Disease. Radiographics. 2016 Oct;36(6):1871-1887.
Manson JE, Brannon PM, Rosen CJ, Taylor CL. Vitamin D Deficiency - Is There Really a Pandemic? N Engl J Med. 2016 Nov 10;375(19):1817-1820
Allen SC, Raut S. Biochemical recovery time scales in elderly patients with osteomalacia. J R Soc Med. 2004 Nov;97(11):527-30.
Motosuneya T, Asazuma T, Yasuoka H, Tsuji T, Fujikawa K. Severe kyphoscoliosis associated with osteomalacia. Spine J. 2006 Sep-Oct;6(5):587-90.
Bikle DD. Vitamin D metabolism, mechanism of action, and clinical applications. Chem Biol. 2014 Mar 20;21(3):319-29.
Arabi A, El Rassi R, El-Hajj Fuleihan G. Hypovitaminosis D in developing countries-prevalence, risk factors and outcomes. Nat Rev Endocrinol. 2010 Oct;6(10):550-61.
O'Mahony L, Stepien M, Gibney MJ, Nugent AP, Brennan L. The potential role of vitamin D enhanced foods in improving vitamin D status. Nutrients. 2011 Dec;3(12):1023-41.
Authors
Copyright (c) 2024 Mohammed Hamoud Muharraq, Yahya Ahmed Abdullah Malhan, Muhammad Saleh Al-Abdulatif, Abdulziz Ali Saad Alharbi, Jaz Farag Ali, Jubran Muhammad Safar Al-Shahrani, Huda Awadh Alazmi
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