Osteomalyation – the system pathological process which is characterized by decrease in durability of bones because of an insufficient mineralization of a bone tissue. As a result of a bone become excessively flexible. Osteomalyation is shown by bone pains, deformations and pathological changes. The hypotrophy and hypotonia of muscles is characteristic, violations of gait and a bearing are possible. The diagnosis an osteomalyation is established on the basis of a X-ray analysis and other researches. Treatment more often conservative, at deformations is carried out surgical correction.
Osteomalyation (from Greek osteon – a bone, malakia – softness) – the system disease of a skeleton which is followed by decrease in durability of a bone tissue. Violations of mineral exchange because of a lack of an organism of vitamins, phosphoric acid and salts of calcium are the reason of an osteomalyation. Less often pathology develops owing to violation of excretory function of kidneys (renal osteodystrophy), the chronic and progressing diseases of kidneys (chronic interstitsialny nephrite, kidneys, , anomalies of development of kidneys).
Osteomalyation is observed mainly at children's and advanced age, very seldom meets during pregnancy. Women suffer 10 times more often than men. At children bones of extremities usually are surprised, pregnant women have basin bones, at elderly – vertebras. Taking into account emergence time in traumatology and orthopedics allocate 4 forms of an osteomalyation: children's or youthful, puerperalny (at pregnant women), climacteric and senile. Among patients with pathology of kidneys people of young age prevail. Besides, cases when the osteomalyation developed at an osteopathy of starving are described – today in the safe countries this pathology occurs mainly at patients with anorexia and the weakened teenage girls.
In bones of the person in parallel there are two processes: destruction of an old bone tissue and education new in combination with its mineralization. Normal these processes are balanced therefore bones keep the durability. At an osteomalyation instead of a full-fledged bone tissue it is formed not mineralized or poorly mineralized (containing few phosphates and calcium) osteoides, representing a congestion of collagenic fibers (a bone basis, proteinaceous ) which give to bones elasticity. Suffers because of violation of processes of formation of a new bone tissue also process of destruction of an old bone owing to what the structure of bones is even more broken, and their durability – decreases.
The mineralization of a bone depends on the content in blood of phosphates and calcium. Depending on a lack of this or that element distinguish two forms of an osteomalyation: kaltsipenichesky and fosforopenichesky. The lack of calcium can be observed at violation of absorption of calcium in intestines, an imbalance between process of adjournment of calcium in bones and its removal from the collapsing bone tissue, a lack of vitamin D and an excessive ekskretion of calcium kidneys. The congenital and acquired violations of synthesis of vitamin D owing to genetic disorders, cirrhosis, diseases of digestive tract, insufficient insolation, long reception of anticonvulsive medicines and a vegetarian diet are the reason of a kaltsipenichesky form of an osteomalyation.
The amount of phosphates in blood is defined by their absorption in intestines and removal speed in kidneys. The Fosforopenichesky form of an osteomalyation arises owing to hyperfunction of parathyroid glands (giperparatireoz), a lack of phosphates of food and the strengthened secretion of phosphates kidneys at some tumors, inherited disorders of a metabolism, diseases of kidneys etc. During pregnancy and a lactation the risk of development of an osteomalyation increases as the need of an organism for vitamin D increases, and load of kidneys raises that can lead to a demonstration of various diseases and manifestation earlier latentno of the proceeding anomalies of development.
Osteomalyation begins gradually. At all four age forms of an osteomalyation similar symptoms come to light: decrease in force and a tone of muscles, not clear pains in hips and a back, is more rare – in shoulders and area of a thorax. The pain syndrome is observed not only at loading, but also at rest. Bones very much early become sensitive to pressure. With a pressure from sides upon podvzdoshny bones pain develops both when pressing, and at the squeezing termination. One more characteristic sign of an osteomalyation are difficulties in attempt to move apart and raise legs. Quite often there are paresteziya.
At initial stages of an osteomalyation of deformation of a skeleton are absent, pathological changes are possible. In the subsequent pains amplify, there are expressed restrictions of movements, deformations of extremities and other anatomic areas develop. In hard cases of a bone become voskovidno flexible, violations of mentality, violation of functions of cardiovascular system and digestive tract are possible. For the rest the clinical picture of an osteomalyation depends on age of patients. At children and teenagers with an osteomalyation tubular bones mainly are surprised, over time there are Au-shaped legs and funneled deformation of a thorax.
The Puerperalny osteomalyation, as a rule, develops in time of repeated pregnancy at women of 20-40 years. Less often the first symptoms of a disease arise in the postnatal period and during breastfeeding. Damage of bones of a basin, the top departments of hips and the lower department of a backbone is characteristic. Patients complain of the leg, back pains, areas of a sacrum and a basin amplifying when pressing. Duck gait is formed, sometimes the osteomalyation is complicated by paresis and paralyzes. Deformed (so-called osteomalyaticheskiya) the basin makes impossible the child's birth in the natural way therefore it is necessary to resort to Cesarean section. After the delivery the condition of patients with an osteomalyation, as a rule, improves, however at absence or inefficiency of treatment consequences in the form of heavy residual deformations and the accompanying working capacity violation are possible.
At a climacteric form of an osteomalyation the backbone curvature prevails, develops . Trunk length gradually decreases, at the same time change of length of extremities does not happen that at pronounced pathology causes a characteristic picture – in a sitting position of people it seems to much more undersized, almost the dwarf. In some cases there is an expressed pain syndrome immobilizing patients. At a senile osteomalyation pathological changes less often – deformations of a skeleton owing to a curvature of bones are more often observed. Sometimes existence of a large number of compression spinal fractures causes formation of the expressed hump. Gait violations (the duck or tripping gait) are quite often observed, there are difficulties in attempt to climb steps. The palpation of bones is painful.
The diagnosis an osteomalyation is exposed taking into account a radiological picture, clinical symptoms and these additional researches. At initial stages in x-ray pictures widespread osteoporosis comes to light. In the subsequent the plastic arc-shaped deformation more noticeable on roentgenograms of the hips and shins which are exposed to considerable axial loadings is defined. In places of a congestion of an osteoid enlightenment zones become visible. At a congestion of an osteoid in a podnadkostnichny zone contours of a bone become indistinct, a cortical layer – layered. At a long current of an osteomalyation and the expressed osteoporosis the cortical layer becomes thinner, the marrowy space extends.
At early stages the osteomalyation is differentiated with system osteoporosis. For this purpose carry out a gamma and photonew absorbtsiometriya (the research allowing to define amount of calcium and phosphates on a certain site of a bone) or carry out a biopsy of bones of a basin. At an exception of tumoral, inflammatory and system diseases of a skeleton use data of a X-ray analysis, and also consider characteristic localization of pathological changes (damage of tubular bones at young people, basin bones – at pregnant women, a backbone – at elderly). At an osteomalyation differentiation with a disease of Recklinghausen take into account lack of zones of reorganization of Loozer, with late rickets – lack of signs of violation of enkhondralny ossification.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Orthopedists and traumatologists, if necessary – with the assistance of nephrologists, gynecologists, endocrinologists and other experts are engaged in treatment of an osteomalyation. Carry out the conservative therapy including reception of vitamin D, phosphorus and calcium, remedial gymnastics, massage and UF-radiation. At the expressed deformations carry out surgical correction, but not earlier, than in 1-1,5 after an initiation of treatment as at early surgeries at patients with an osteomalyation repeated deformations are often observed.
At the osteomalyation which arose during pregnancy also appoint the medicines containing a large number of minerals and vitamin D. At inefficiency of therapy termination of pregnancy, after the delivery – sterilization and the termination of feeding is shown by a breast. At a favorable current carry out Cesarean section and recommend not to nurse the child. The forecast for life at a timely initiation of treatment in most cases favorable, disability owing to heavy deformations of a basin and a backbone is possible. In the absence of treatment patients with an osteomalyation perish from associated diseases and complications from internals.