Osteomalacia is known as soft bone disease. It is a metabolic bone disease. It resulted by inadequate bone tissue mineralization caused by deficiency of phosphate, calcium, or vitamin D. This can weaken and soften the bones. It is a nutritional deficiency. Rickets in children and osteomalacia in adults are major. Remodeling of bone includes different cell types like osteoclasts and osteoblasts. Osteoclasts break the bone, and osteoblasts generate mineralized bone. It is regulated by hormonal signals like calcitonin and parathyroid hormone (PTH). When levels of vitamin D reduce, PTH mobilizes calcium from bones to regulate the serum levels. This may lead to osteomalacia, specifically in adults who have impaired metabolism of vitamin D, which can cause bone calcium extraction and clinical symptoms. 

In adult Europeans, Osteomalacia is about 25% common. The incidence is underestimated globally. Population with limited sum exposure, low socioeconomic status, dark skin, poor diet, and cover bodies with full clothing are at risk. It is often impacted by geographic area, ethnicity, and cultural practices. 

Metabolism of vitamin D is important to understand the pathophysiology of osteomalacia. Production of vitamin D or calcitriol starts in the skin by conversion of 7-dehydricholesterol to pre-vitamin D, which triggers the UVB radiation in the skin. It forms vitamin D3, which is cholecalciferol, and converts it into calcidiol in the liver. Individuals who have chronic liver disease because of this conversion are at high risk. Calcidiol is an important indicator of status of vitamin D. It includes dietary intake, sunlight exposure, storage into the liver. Conversion of calcitriol occurs by enzyme 1-alpha-hydroxylase in the kidney. It is a regulated feedback mechanism which involves the level of serum phosphate, FGF-23, and parathyroid hormone. The body controls the process by feedback loops in the hormones and other factors. The risk factor is chronic kidney disorder, which can lead to hyperparathyroidism.  

Osteomalacia is a bone disorder. It weakens the bone due to a lack of minerals. It is caused by deficiency and absorption problems in vitamin D, renal disease, which can not process calcium, vitamin, or phosphorus imbalance, certain drugs, and tumor-induced osteomalacia.  

Osteomalacia occurred by deficiency in vitamin D. It is treatable and curable disease. Treatment may need customization by patient condition. Any improvement in lab test and symptoms relief is noticeable within weeks of the treatment. Full recovery need many months to year depending on the causes.  

 It is important to collect a brief family history of patients and surgery in the past to evaluate osteomalacia. It is also important to assess the lifestyle and dietary pattern of patients. Necessary questions can be asked to patient about the activity, interest, and dietary preferences like vegetarian.   

The symptoms of osteomalacia are diverse. It does not have specificity. Symptoms may include bone pain, specifically in the lower spine, lower limbs, and pelvis, and muscle weakness and wasting, specifically in proximal muscles. Patients who have arthralgias, myalgias, increased levels of falls, muscle spasms, and altered gait can worsen the activity. 

Osteomalacia can also lead to deformities of limbs, pelvis, or spine in the long term. Severe cases may have tetany or hypocalcemic seizures. 

The presentation of osteomalacia differs. Patients may have fatigue and musculoskeletal pain. As the disease progresses, symptoms like aching, muscle weakness in proximal muscles, and bone pain, and elevated risk of fractures appears. In severe cases, it may lead to hypocalcemic seizures or tetany. Prior recognition and treatment are important to prevent the complications.  

• Diagnose and identify the underlying or main cause. 
• Vitamin D supplements to treat the deficiency of vitamin D. 
• Calcium supplements to improve bone health. 
• Sun exposure and dietary supplements. 
• Monitor the levels of vitamin D and bone health markers. 
• Address any conditions if exist. 
• Additional physical therapy and lifestyle changes.  

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Spend more time in outdoors in moderate sunlight as it is beneficial for natural production of vitamin D. Consume diet which is rich in calcium and vitamin D like leafy green vegetables and fatty fish to improve bone health. 

Weight bearing exercise and strength training improve the bone density and muscle strength. Remove any hazards and any devices at home which can increase the risk of fractures. Quite smoking will improve the overall health of bone and reduce the risk of osteomalacia. Moderate alcohol consumption may help to maintain density of bone and prevent fractures. 

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Ergocalciferol (vitamin D2):  

It is used to treat osteomalacia. It is administered orally. The dose is adjusted on the basis of severity of deficiency and condition of patient. Regularly monitor the levels of vitamin D to make sure the proper supplements are given. Calcium supplements and changes in lifestyle may improve bone health. Healthcare providers monitor the adverse effects like hypercalcemia and adjust the dose as per need. Long-term use of ergocalciferol can be required to maintain the levels of vitamin D and prevent the recurrence of osteomalacia.  

Cholecalciferol (vitamin D3):  

It is used to treat osteomalacia. It is administered orally. The dosage is adjusted on the basis of severity of deficiency and other factors. It can be combined with other calcium supplements to improve bone health. Healthcare providers monitor the adverse effects like hypercalcemia and adjust the dose as per need. Long-term use of cholecalciferol can be required to maintain the levels of vitamin D and prevent the recurrence of osteomalacia.  

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Calcidiol:  

Calcidiol is a precursor component to activate vitamin D. It is used to treat osteomalacia. It is administered orally. The dosage is adjusted on the basis of severity of deficiency and other factors. It can be combined with other calcium supplements to improve bone health. Healthcare providers monitor the adverse effects like hypercalcemia and adjust the dose as per need. Long-term use of calcidiol can be required to maintain the levels of vitamin D and prevent the recurrence of osteomalacia.  

Calcitriol:  

An acitve form o vitamin D is calcitriol. It is used to treat osteomalacia. It is administered orally. The dosage is adjusted on the basis of severity of deficiency and other factors. It can be combined with other calcium supplements to improve bone health. Healthcare providers monitor the adverse effects like hypercalcemia and adjust the dose as per need. Long-term use of calcidiol can be required to maintain the levels of vitamin D and prevent the recurrence of osteomalacia.  

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A simple nutritional plan includes eat food which are high in calcium and vitamin D like leafy green vegetables, dairy food, fish to manage osteomalacia. If required, supplements can also be taken. Get some sunlight and stay hydrated. Avoid too much alcohol, caffeine, and phosphorus. Keep a healthy weight and check regularly to healthcare provider to take the following. 

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Fracture Repair: 

Surgery may be necessary to repair the fractures occurred because of the weaken bone in osteomalacia. This includes plates, crews, or rods to promote proper healing and stabilize the bone.  

Bone Grafting:  

In cases where bone loss their forms, bone grafting procedures can be used to enhance or replace the damaged bone tissue and get the restoration of bone strength and structure. 

Joint Replacement:  

Severe joint damage from osteomalacia, specifically in weight bearing joint like knees or hips may need joint replacement surgery to get rid of pain and improve the mobility. 

Correction of Deformities:  

Surgical procedures can be necessary to rectify skeletal deformities which is occurred from prolonged osteomalacia. This may include osteotomy and realignment procedures to get proper bone alignment and function. 

Parathyroid Surgery: 

In cases where osteomalacia lead to hyperparathyroidism, surgical removal of abnormal parathyroid tissue can be important to normalize the levels of calcium and improve health of bone. 

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Diagnosis:  

The first step includes to recognize and confirm the presence of osteomalacia by clinical assessment, imaging techniques like bone scans and X-ray and laboratory tests to check the level of vitamin D and bone health markers. 

Treatment Initiation:  

Address the main cause of osteomalacia and vitamin D deficiency. This can lead to treatment options like administration of vitamin D and calcium supplements, lifestyle changes to improve bone health. 

Monitoring and Adjustment:  

Monitor the level of vitamin D, bone health markers, and response of patient to treatment throughout the treatment. Adjust the dose of supplements can be necessary depends on the ongoing evaluation. 

Symptom Management:  

Effective management of symptoms like muscle weakness, bone pain, and fractures is necessary. Therapy like pain management, physical therapy and use of supportive device can improve the quality of life of patient. 

Long-term Maintenance:  

Continuous improvement and normalized levels of vitamin D are necessary to maintain it. This includes continued supplements, regular monitoring, and lifestyle practices.