Osteomalacia: what it is, causes, symptoms, diagnosis and treatment features. Softening of bone tissue as a consequence of osteomalacia

Osteomalacia is a disease that begins to progress due to impaired mineralization of bone tissue. As a result, pathological softening of the bones occurs. The disease in its etiology and clinical picture resembles a disease such as rickets in children, which occurs due to hypovitaminosis D3.

In children this pathology leads to softening of the fontanelles. The condition is extremely dangerous, since as a result of its progression, the skull gradually softens and becomes deformed.

Causes

Was held great amount clinical trials, during which scientists tried to determine why a person’s bone structure softens and osteomalacia develops. It was found that this pathology is generalized. This suggests that violations mineral metabolism occur throughout the body, but most often the pathological process is localized in the bones. Exact reasons The development of pathology has not been identified to date.

Basic etiological factors development of osteomalacia:

• nutritional reasons. These include vitamin D deficiency, phosphoric acid and calcium. In medicine, there have also been cases where osteomalacia developed during a diet;
• changes in hormonal levels;
• degenerative-dystrophic diseases – common reason development of osteomalacia;
• low levels of vitamin D3 and calcium in organism.

All stated reasons lead to the progression of osteomalacia. It is important to remember that the earlier the disease is detected, the easier it will be to treat. This is especially true for young children.

Symptoms in adults

Clinicians distinguish 4 forms of osteomalacia:

• pueral. In this form, the disease affects the vertebral structures. As a result, the spine is curved with a displacement in the lateral plane, and a flattening of physiological kyphosis and lordosis occurs;
• rachitic. This form of the disease occurs in children who have started puberty. The patient has anatomical deformation of the thoracic region, lateral deformation of the spinal column, kyphosis in the thoracic region. Characteristic cramping muscle spasms are also observed. The person begins to walk in small steps;
• menopausal. The form occurs in women due to a lack of estrogen. In women it shortens lumbar region spine. This may cause changes in height. Appearance women changes, and in medical circles it is called “sedentary dwarf”. As the disease progresses, other symptoms appear. Thus, a woman develops an “alternating gait.” Because of this, it is very difficult for the patient to climb stairs ( characteristic symptom). This form of the disease is often accompanied by numerous fractures due to the fragility of the bones;
• senile form of osteomalacia. This condition in humans it progresses due to the occurrence of multiple metabolic defects.

Symptoms in children

The main symptoms of the disease in children:

• presence of Looser zones. These are small areas where a decrease in density is expressed bone tissue;
• Milkman syndrome. His characteristic feature is calcium deficiency in the bones;
• with Renoir's symptom on X-ray image bone decalcification is clearly visible;
• deformation of the pelvis according to the “ace of hearts” type – flattening downwards and widening upwards. This is a characteristic symptom of pathology.

Loozer zones are specific symptom which manifests itself in children. Areas of clearing form in the bones, which are visible on photographs in the form of cracks, stripes, and wedges.

Diagnostics

If you suspect osteomalacia, you should immediately contact a qualified specialist to conduct a thorough diagnosis and prescribe the correct course of treatment. Diagnostic measures are the same for both adults and children, and include:

• laboratory test (it is important to establish the level of alkaline phosphatase);
• X-ray examination;
• biopsy of bone tissue at the location of the Looser zones;
• if necessary, they may additionally prescribe a CT scan (more often used to diagnose the disease in children).

Treatment

First of all, you should immediately address the deficiency of vitamin D, phosphorus and calcium, since without this further treatment will simply be ineffective.

Patients are prescribed medication:

• vitamin D. Calcitriol or alfacalcidiol is administered intramuscularly;
• It is also recommended to take oral vitamins and mineral complexes. Children are prescribed vitamin D3 drops;
• B vitamins and vitamin C are necessarily prescribed, which enhance the absorption of vitamin D3, thereby increasing the effectiveness of treatment.

Treatment of the disease occurs quite long time and requires a lot of effort. If treatment is not carried out in a timely manner, the disease may develop into chronic form. Under no circumstances should you treat osteomalacia yourself. If you suspect the development of this disease, you must visit qualified specialist who can prescribe the correct course of treatment.

Diet

During treatment of the disease, it is important to adhere to special diet. First of all, it should include foods rich in calcium and vitamin D. Nutrition for osteomalacia should be fractional.

The diet must include:

• fruits;
• vegetables;
• fermented milk products (cow's or goat's milk, low-fat cottage cheese, yogurt, fermented baked milk, kefir);
• wheat bread;
• greens (basil, broccoli, cilantro, parsley and dill);
• meat (steamed);
• fish;
• hard cheeses (several slices per day);
• sardines;
• tomatoes;
• beans;
• liver;
• eggs;
• pumpkin;
• zucchini;
• mushrooms (honey mushrooms, boletus);

It is necessary to limit the use of:

• salt;
• meat in large quantities.

Prohibited for use:

• alcohol;
• strong tea;
• coffee;
• carbonated drinks;
• energetic drinks.

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Diseases with similar symptoms:

Hyperparathyroidism – chronic pathology parathyroid glands, progressing due to the occurrence of tumors or increased proliferation of their tissues. The pathology is characterized by increased production of parathyroid hormone, which affects calcium metabolism. Its excess content in the blood causes calcium to be washed out of the bones, and this, in turn, leads to serious complications.

Flat feet are a type of deformation of the foot area in which its arches are subject to lowering, resulting in a complete loss of their inherent shock-absorbing and spring functions. Flat feet, the symptoms of which include such basic manifestations as pain in the area calf muscles and a feeling of stiffness in them, increased fatigue when walking and standing for long periods of time, increased pain in the legs at the end of the day, etc., is the most common disease affecting the feet.

Clinical picture and course. The disease begins gradually and has a long course. There may be cases of rapid, progressive course with a legal outcome.

The leading symptoms are vague pain in the back and hips, less often in the shoulder and chest, permanent in nature, occurring even at rest. Bone sensitivity to pressure appears very early. Pain occurs as if lateral compression of the scallops occurs iliac bones, and when pelvic compression stops. Early characteristic feature Contracture of the adductors also serves as a cause - it is difficult to lift and spread the legs (Fig. 3). Paresthesia appears quite early. At the onset of the disease, the bones exhibit only increased fragility. As the disease progresses, pain in the bones intensifies, movements become completely impossible, and deformities appear in the skeleton. In advanced stages of the disease, the bones become waxy. At severe forms diseases may be mental disorders, gastrointestinal tract and cardiovascular system.

Clinical picture of the puerperal form - see below.

Diagnosis of initial forms in the absence of pronounced clinical manifestations presents significant difficulties. As the disease progresses, diagnosis is facilitated by the peculiar localization of the lesion, characteristic of each form of osteomalacia (Fig. 4 and 5).

Rice. 3. Adductor contracture in osteomalacia.
Rice. 4. A 54-year-old woman with osteomalacia for 4 years (menopausal form).
Rice. 5. A patient with a severe form of osteomalacia (according to Bumm).

In childhood and juvenile forms of osteomalacia, deformation occurs mainly in the bones of the extremities. Quite early you can detect the beginning funnel-shaped deformation chest or slight curvature of the legs: when the feet are closed, they move away a few centimeters knee joints, and with closed knees - feet.

With severe puerperal form of osteomalacia, the entrance to the pelvis becomes characteristic shape"card heart"

With climacteric osteomalacia, kyphosis attracts attention, the lumbar region seems shortened, and in advanced cases, a shortening of body length is actually observed. Since only the body is shortened, the picture of a “sitting dwarf” appears. Only in rare cases does it come to such curvatures of the skeleton, which, combined with soreness of the bones, lead to complete immobility.

With senile osteomalacia, changes in the pelvis recede into the background, but more often than with the menopausal form, multiple fractures are observed. While in mild cases walking is not impaired, in moderate cases a waddling gait is typical.

There is also a gait in small steps, as in parkinsonism. Walking up stairs is especially difficult.

From laboratory data highest value has a promotion alkaline phosphatase in the blood, indicating increased activity osteoblasts. The calcium and phosphorus content is usually slightly reduced. In unclear cases, bone biopsy of the iliac crest should be resorted to. Finally, with diagnostic purpose The results of a trial of vitamin D therapy for 3-6 weeks may also be used.

X-ray diagnosis of osteomalacia. First radiological sign osteomalacia is a common osteoporosis (see), the degree of which is more significant the longer and more intense the disease proceeds. Subsequently, plastic arched deformation of the bones, characteristic of osteomalacia, occurs. The presence of osteoid tissue contributes to an even greater severity of osteoporosis and creates clearing zones in places where it accumulates, disrupting the clarity of the contours of the compact bone substance and the structure of the spongy bone tissue. With the accumulation of osteoid substance under the periosteum and along the Haversian canals, in addition to the unclear contours of the bone, the layered nature of the pattern of the cortical layer is determined. A significant degree of osteoporosis is characterized by the almost complete disappearance of the crossbars spongy bone. In this case, the bone marrow space is significantly expanded, and the cortical layer is sharply thinned.

The value of X-ray diagnostics in early recognition of the disease is small (S. A. Reinberg), since early sign osteomalacia - osteoporosis - occurs in many other diseases. However, even in early cases osteomalacia, the systemic nature of osteoporosis, despite the predominant damage to one or another part of the bone skeleton, acquires important differential diagnostic significance.

X-ray examination makes it relatively easy to distinguish osteomalacia from inflammatory and tumor diseases. From systemic diseases skeletal osteomalacia is distinguished by the characteristic localization of bone changes: in the juvenile form it is a lesion of the tubular bones, in the puerperal form it is a lesion of the pelvic bones, in the senile form it is a lesion of the spine.

In contrast to imperfect bone formation (see Osteogenesis imperfecta), bone deformation in osteomalacia is not angular, but arched. With Recklinghausen's disease, cellular, racemose clearings and thickening of the bones are observed, which do not occur with osteomalacia, and Looser zones of restructuring (see), very characteristic of osteomalacia, are much less common with Recklinghausen's disease. Main hallmark Juvenile osteomalacia from late rickets is the absence of a violation of enchondral ossification in osteomalacia. See also Osteodysplasia, Osteodystrophy.

Forecast with osteomalacia severe. Death occurs not so much from the underlying disease as from complications from internal organs, as well as from concomitant diseases.

Prevention and treatment. The main task of prevention and treatment is to improve social, everyday and hygienic conditions life. There is a need for rational and good nutrition, rich in vitamins(especially vitamin D), lime salts and phosphates.

State skeletal system depends on many factors. It is affected by both diet and activity. endocrine system, and the presence of various diseases of organs and systems in humans. Violation normal condition skeletal system is fraught different problems with health, they depend on the type of illness, the patient’s age and his individual characteristics. So a rather serious disease of this type in adults is osteomalacia, the symptoms, treatment and causes of which we will consider in a little more detail.

By the term “osteomalacia,” doctors mean a systemic lesion in which there is insufficient mineralization of bone tissue. Many experts compare it with rickets, only in adult patients. Most often the disease is recorded in women.

Why does osteomalacia occur, what are the causes of the lesion?

Experts say that the cause of osteomalacia can be either a violation of its metabolism. In addition, a deficiency can cause such a disease minerals, provoked by their excessive filtration by the kidneys or impaired absorption in the intestine. With osteomalacia, the patient's total bone substance, but it is depleted in minerals.

Osteomalacia is recorded in patients of different ages- during puberty, in the puerperal (postpartum) period, during, and also in old people. In some cases, the disease develops without regard to age; it is called excretory osteomalacia, in this case the body is suffering from kidney disease.

Symptoms of osteomalacia

With all types of osteomalacia, relatively identical symptoms are observed - vague painful sensations in the area of ​​the back and hips. Some patients report pain in the shoulder and chest area.

On initial stage As the disease progresses, the skeleton does not become deformed, but over time, curvature of the legs becomes noticeable. In this case, the knee joints are slightly retracted to the sides if you close your feet. If you close your knees, your feet will move apart. In addition, if the disease progresses too far, a funnel-shaped chest deformity occurs.

If osteomalacia develops during menopause, patients have especially pronounced kyphosis, and over time, their body length is shortened by an order of magnitude. Shortening is observed only on the torso, which is why patients become like sessile dwarfs. In rare situations, the curvature of the skeleton becomes especially pronounced and causes severe pain, as a result of which patients become completely immobilized.

Osteomalacia in older people leads to frequent and multiple fractures. Changes in the pelvis are not very pronounced. At the initial stage of development of the disease, gait is not disturbed, but as it progresses further, patients begin to walk, waddling to the left and to the right. In some cases, the gait becomes mincing or shuffling. Patients have difficulty climbing stairs, and their bones become sensitive to pressure. Patients feel pain during compression of the iliac bones and when they are released.

If osteomalacia progresses quite far, patients may experience fractures. Often they affect only one layer of bone, grow together very difficultly and can exist for a long time without any displacement. Doctors often encounter multiple bone fractures.

How is osteomalacia corrected, what is the treatment for the lesion?

Many doctors are involved in the treatment of osteomalacia, primarily orthopedists and traumatologists. Correction can be carried out with the involvement of nephrologists, gynecologists, endocrinologists and other specialists. Conservative treatment usually includes taking phosphorus and calcium supplements. Patients are advised to undergo therapeutic exercises, massage, etc.

If the disease has led to particularly pronounced deformities, carry out surgical correction. However, surgery can only be performed one to one and a half years after the start of therapy. If you carry out surgery earlier, the patient may experience repeated deformities.

If osteomalacia develops in women carrying a child, they are also prescribed medications containing a lot of microelements and vitamin D. If such therapy does not have a positive effect, doctors may insist on terminating the pregnancy. If childbirth occurs, the patient is indicated for sterilization, and she also needs to stop breastfeeding. If osteomalacia in pregnant women proceeds favorably, childbirth is carried out by. It is better for such mothers to stop breastfeeding (to prevent the loss of calcium and other nutrients).

Fortunately, timely initiation of treatment for osteomalacia can stop the progression. pathological processes. But further destruction of bone tissue is fraught with the development of disability due to severe deformations of both the pelvis and the spine. If therapy is not carried out completely, patients may die from concomitant ailments and complications affecting internal organs.

Traditional treatment osteomalacia folk remedies

Osteomalacia is a very serious health disorder that requires targeted treatment under the supervision of a qualified specialist. In the treatment of such an ailment, various medications can be used, and in addition to them, drugs based on traditional medicine.

Thus, patients with osteomalacia may benefit from taking an infusion based on a series. It can be purchased at the pharmacy, and this plant is rightfully considered one of the safest; it is often recommended to be given even to children. For cooking medicine you need to brew a couple of tablespoons of crushed plant material with half a liter of boiling water. Cover the medicine with a lid and set aside for half an hour. Drink the strained drink a day in two, three or four doses.

Burdock can also be used to soften bones. Healers advise using the root of this plant, dried and crushed. Brew a tablespoon of this raw material with half a liter of boiling water and leave for two hours to infuse. Strain the finished medicine and take a third of a glass hot three or four times a day.

Some healers claim that for successful treatment For osteomalacia, external methods can also be used. So they can give a good effect medicinal baths. To prepare one of them, you need to combine two hundred grams of elecampane roots with the same amount of burdock root. Brew the resulting mixture with a bucket of boiling water (ten liters) and simmer over medium heat for a quarter of an hour. Strain the finished product and pour it into the prepared bath.

Even with osteomalacia, you can prepare one hundred and fifty grams of marsh calamus roots and the same amount of nettle roots. Such raw materials should also be brewed with a bucket of boiling water and boiled for ten minutes. After boiling, cover the container with a lid and let the medicine brew for fifty minutes. Pour the strained broth into the prepared bath.

Patients with osteomalacia can also turn their attention to a mixture of string with yarrow. Combine four hundred grams of the first herb with one hundred grams of the flowers of the second. Brew with ten liters of boiling water and simmer over medium heat for five minutes. Infuse the medicine for fifty minutes, then strain. Pour the broth into the prepared bath.

Baths for osteomalacia should be warm - close to body temperature (or slightly higher). The duration of one such procedure is fifteen to twenty minutes, after which you need to blot your body with a towel (without rubbing) and go to bed. Repeat such baths at intervals of a day; in total, you should complete at least ten procedures.

To saturate the body with calcium, traditional medicine specialists often advise using products based on. To prepare one of them, it’s worth preparing a dozen fresh chicken eggs(with white shell), kilogram of honey, Fresh Juice, obtained from three lemons, and half a liter of quality cognac.

Wash the eggs under running water, place them in a large jar and fill lemon juice(it should completely cover the shell). Wrap the container in a blanket and leave for three to four days. During this time, the shell should dissolve. Wipe the contents of the jar through a sieve, stir in a bottle of cognac and a kilogram of honey. Mix well, pour into dark bottles and refrigerate. You need to drink this medicine one glass three times a day, shortly after meals.

If you suspect osteomalacia, it is best to consult a doctor as soon as possible. Lack of timely treatment is fraught with serious health problems. The advisability of using traditional medicine must first be discussed with your doctor.

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Osteomalacia: what is it? The disease is a disorder of bone tissue mineralization. As a result, the bones soften, they become brittle and susceptible to various kinds injuries and damage. The clinical picture of the disease resembles rickets in children, which appears due to a lack of vitamin D3. This system process, because all the bones in the body soften. Previously, this disease was quite rare. However, at present, due to the current modern life every tenth person suffers from this disease. In most cases, mineralization of bone tissue is observed in women, sometimes osteomalacia occurs in animals.

Classification of the disease

This pathology is divided into many types, the nature of which depends on certain factors. On this moment The following types of osteomalacia are distinguished:

1) Depending on the course of the disease:

• deficiency, that is, hypovitaminosis;
• vitamin-resistant, occurs due to damage to the intestines or kidneys.

2) Depending on chemical element who participates in the exchange:

• phosphopenic;
• calcipenic.

3) Depending on the gender and age of the patient:

• puerperal (osteomalacia in pregnant women);
• senile (occurs due to age-related changes);
• juvenile (appears during puberty);
• menopausal.

Causes of the disease

To understand why this disease appears and what precedes it, a huge amount of research has been conducted. Scientists are perplexed as to why bones become soft and osteomalacia develops. As a result of many experiments, experts found that the pathology is generalized. In other words, this means that it is formed throughout the body. In most cases, the lesion is located in the bones. Today, doctors find it difficult to name specific reasons.

However, the research was not in vain, and it was possible to find out what factors influence this process. So, they highlight following reasons osteomalacia:

• changes in hormonal levels;
• lack of vitamin D3 and calcium in the body;
• dystrophic diseases.

These factors are activators for the progression of the disease. It is worth remembering that the earlier the disease is detected, the easier it will be to cure it.

What influences the development of pathology?

Osteomalacia: what is it? As already noted, the disease is associated with softening of the bones. For many years, the best scientists have tried to figure out what causes the disease? As a result of research, certain reasons were identified. In more than 60% of patients, no metabolic abnormalities were found, and in childhood was in the body sufficient quantity vitamin D. However, by the age of 30-40, each of them was diagnosed with mineralization of bone tissue. This suggests that the roots of osteomalacia are buried in a genetic trait.

Scientists have also found out what matters hormonal background. After all, softening of bones occurs more often in women than in men. In addition, it is worth noting that most patients in one way or another belong to representatives of specific professions. This means working in chemical plants, living in an environmentally unfavorable area, etc.

Signs of osteomalacia

There are two ways of developing the disease: asymptomatic and with the manifestation of certain symptoms. In the first case, the disease is detected on an x-ray, most often by chance. But there are situations when the symptoms of osteomalacia are quite pronounced.

Distinguish following signs diseases:

• constant, unrelenting pain. Patients most often complain of pain in the heels, knees, ribs, pelvis, and lower back. Moreover unpleasant feelings occur both under certain types of loads and when pressure is applied to the bone;
• flashes of severe pain. Due to the fact that bones become brittle, even light load on the musculoskeletal system can lead to fracture or deformation. It causes severe pain, which can pass quickly and soon recur;
• muscle weakness. Hypovitaminosis leads to impairment muscle functions. As a result, the patient experiences instability while walking, poor coordination of movements, and other cases associated with muscle weakness.

Diagnostics

Osteomalacia syndrome is diagnosed based on the patient's complaints, medical history, external examination and research results. If the disease is in initial stages, identifying it is quite simple. The patient undergoes standard procedures, after which the doctor makes an accurate diagnosis.

In case of a long-term course of the disease, the specialist will need more data about the patient. In order not to be mistaken in identifying the disease, the doctor asks the patient to undergo additional procedures. Most often this is an ECG, ultrasonography etc. It is important to note that osteomalacia in half of the cases is accompanied by osteoporosis. It is characterized by multiple fractures. Therefore, the doctor must conduct studies based on an assessment of bone tissue density.

Possible complications

It is worth noting that osteomalacia is very serious illness, and ignoring this disease can lead to negative consequences. Delayed diagnosis negatively affects not only the functioning of the musculoskeletal system, but also the body as a whole.

Osteomalacia: the process of death of old cells, which, among other things, is an obstacle to the mineralization of new cells. Thus, all bone tissue becomes “soft”, which leads to significant deformations of the skeleton. This, in turn, affects the internal vital organs. As a result of deformations of the chest and pelvis, very serious problems With bladder, heart, lungs, intestines, etc.

Therapy

Once specialists have discovered osteomalacia in a patient, the treatment process begins. Of course, before prescribing a course of therapy, you should first understand the reasons. If doctors can identify them, it will be big victory. Then the treatment of osteomalacia will be aimed at eliminating the factors that were activators of the disease.

Therapy is prescribed not by one doctor, but by a group of specialists. For this, a gastroenterologist, surgeon, orthopedist, etc. are involved. Sometimes ten or more different doctors are brought together for correct treatment so that the methods are most effective. When prescribing therapy, we must not forget about complications that can arise at any time. Therefore, the patient is recommended to visit several more specialized specialists, such as a cardiologist, neurologist or pulmonologist. Such a collaboration of doctors is able to prescribe the most effective method treatment.

With the help of medications

After osteomalacia is detected, specialists choose a method of therapy. There are two methods: medication and surgery. The latter is used in limited cases. Regarding treatment with medicines, then it consists mainly of injections of vitamin D. Large doses are administered initially, gradually reducing them as treatment progresses. In addition, doctors often prescribe oral vitamins B and C.

The fact is that they have an indirect effect on phosphorus and calcium metabolism, and also normalize the work nervous system. This is especially effective when muscle weakness caused by osteomalacia. Vitamins B and C are aimed at enhancing the activity of vitamin D. It is worth noting that treatment should be carried out under the strict supervision of the attending physician. This is due to the fact that taking medications requires constant monitoring of urine and blood parameters and, if necessary, dose changes.

Surgical intervention

As already noted, this method is used in limited cases. It is used for the following conditions:

• when bone deformations disrupt the functioning of internal vitals important organs. In this case, doctors use vertebroplasty. It consists of strengthening the vertebrae using medical cement and polymers. Sometimes rib fixation is used and pelvic bones special designs;
• multiple fractures accompanied by slow healing. Then doctors recommend the introduction of a medical structure that will fix the bone in the correct position. This design is placed during fusion and consists of metal or polymer.

In any case, such decisions are made by the doctor with the consent of the patient.

How does a diagnosis of osteomalacia affect your lifestyle?

The symptoms and treatment of osteomalacia have a profound impact on the patient's life. He will need to completely reconsider his usual existence, as well as make changes to his diet.

So, some advice from experts:

• The first step is to replace the regular bed and mattress with orthopedic ones. It is desirable that there be provisions different zones rigidity for proper distribution of body weight. Since softening of the bones can lead to problems with the spine, this requirement cannot be ignored. You also need to create your daily routine so that you have time for proper rest;
• if work requires being in a static position for a long time, then you need to get up and do a warm-up at least once an hour. It will be enough to walk around the office for a few minutes or climb one flight of stairs;
• it is important to comply drinking regime. This requirement is especially relevant if osteomalacia is accompanied by osteoporosis. It must be remembered that the volume of all liquid should not exceed 2 liters per day. The attending physician will advise correct mode drinking, and must be adhered to;
• if the patient overweight, you need to try with all your might to get rid of it. Reducing body weight helps reduce stress on the bones.

Conclusion

Osteomalacia: what is it? In this article we looked at this concept. This is a disease characterized by impaired mineralization of bone tissue. As a result of this impact, the bones soften, which leads to unpleasant consequences.

After detecting a pathology, it is necessary to follow the doctor’s recommendations. As practice shows, in disciplined patients the development of osteomalacia stops and the pain disappears. In some cases, it is possible to cure anatomical defects. Therefore, to get rid of this disease, you need to strictly monitor your health and listen to your doctor.

is a systemic decrease in bone strength due to insufficient mineralization of bone tissue. As a result, the bones become overly flexible. The pathology is manifested by bone pain, deformities and pathological fractures. Characterized by muscle wasting and hypotonia, gait and posture disturbances are possible. The diagnosis is established on the basis of anamnesis and objective examination, results of radiography and other studies. Treatment is often conservative; in case of deformities, surgical correction is performed.

Puerperal osteomalacia usually develops during repeat pregnancy in women 20-40 years old. Less often, the first signs of the disease appear in postpartum period and during breastfeeding. Characterized by damage to the pelvic bones, upper sections hips and lower section spine. Patients complain of pain in the legs, back, sacrum and pelvis, aggravated by pressure. Formed duck walk, sometimes osteomalacia is complicated by paresis and paralysis. A deformed (so-called osteomalatic) pelvis makes it impossible to bear a child. naturally, so we have to resort to a caesarean section. After childbirth, the condition of patients with osteomalacia, as a rule, improves, but in the absence or ineffectiveness of treatment, consequences in the form of severe residual deformities and concomitant disability are possible.

In the climacteric form of osteomalacia, spinal curvature predominates and kyphosis develops. The length of the body gradually decreases, while there is no change in the length of the limbs, which, in the case of pronounced pathology, causes a characteristic picture - in a sitting position, a person seems much shorter, almost a dwarf. In some cases, there is a pronounced pain syndrome, immobilizing patients. In senile osteomalacia, they are more often observed pathological fractures and less commonly, skeletal deformities due to bone curvature. Sometimes the presence of a large number of compression fractures of the spine causes the formation of a pronounced hump. Gait disturbances (duck gait or mincing gait) are often observed, and difficulties arise when trying to climb stairs. Palpation of the bones is painful.

Diagnostics

The diagnosis of osteomalacia is made taking into account the x-ray picture, clinical symptoms and data additional research. In the initial stages x-rays widespread osteoporosis is detected. Subsequently, a plastic arcuate deformation is determined, more noticeable on radiographs of the thighs and legs, which are subjected to significant axial loads. In places where osteoid accumulates, zones of clearing become visible. When osteoid accumulates in the subperiosteal zone, the contours of the bone become unclear, and the cortical layer becomes layered. At long term osteomalacia and severe osteoporosis, the cortical layer becomes thinner, the bone marrow space expands.

On early stages osteomalacia is differentiated from systemic osteoporosis. To do this, gamma photon absorptiometry is performed (a study that allows you to determine the amount of calcium and phosphate in a certain area of ​​the bone) or a biopsy of the pelvic bones is performed. When excluding tumor, inflammatory and systemic diseases of the skeleton, radiographic data are used, and the characteristic localization is also taken into account pathological changes(damage to tubular bones in young people, pelvic bones in pregnant women, spine in elderly women). When differentiating osteomalacia from Recklinghausen's disease, the absence of zones of Looser's rearrangement is taken into account; with late rickets, the absence of signs of impaired enchondral ossification is taken into account.

Treatment of osteomalacia

The pathology is treated by orthopedic traumatologists, if necessary, with the participation of nephrologists, gynecologists, endocrinologists and other specialists. Conservative therapy is carried out, including taking vitamin D, phosphorus and calcium, therapeutic exercises, massage and UV irradiation. In case of severe deformities, surgical correction is performed, but not earlier than 1-1.5 years after the start of treatment, since in early cases surgical interventions Patients with osteomalacia often experience repeated deformities.

For osteomalacia that occurs during pregnancy, drugs containing a large number of microelements and vitamin D. If therapy is ineffective, termination of pregnancy is indicated, after childbirth - sterilization and cessation of breastfeeding. If the course is favorable, perform C-section and recommend not to breastfeed the baby.

Prognosis and prevention

The prognosis for life with timely initiation of treatment in most cases is favorable; disability is possible due to severe deformities of the pelvis and spine. If left untreated, patients with osteomalacia die from concomitant diseases and complications from internal organs. Prevention includes timely detection and treatment of diseases that can cause the development of pathology.