Osteomalacia - Treatment

Treatment for osteomalacia depends on the underlying cause of disease and includes pain control and orthopedic surgery, when indicated. Health surveillance of renal osteodystrophy include maintaining normal serum calcium and phosphorus, vitamin D and phosphate therapy, reducing excessive exposure to aluminum and iron or aluminum chelation treatments to reduce toxicity.The aim of treatment is bone remineralization without causing hypercalcemia or hypercalciuria, which suggests vitamin D. Vitamin D toxicity is safe when it is managed properly. In patients with vitamin D deficiency osteomalacia 50. 000-100. 000 IU per day for 1-2 weeks, followed by maintenance dose of 400-800 IU per day is sufficient. If there is malabsorption maintenance dose is 10. 000-50. 000 IU per day. It will carefully monitor the level of calcium in urine and serum.
In neoplastic osteomalacia doses of vitamin D and phosphate may further improve the disease but is a difficult and uncertain therapy.It is important to remove the tumor.In diseases hypophosphatemia, renal and intestinal forms including congenital and neoplastic osteomalacia, phosphorus supplementation is critical. Oral phosphate tends to cause diarrhea. To minimize the effect of potassium and sodium phosphate should be administered in small doses to increase gradually to bring the phosphate level to normal. Elemental phosphorus should be taken with a glass of water. Excessive phosphate therapy can cause hypocalcemia. All patients with osteomalacia require an adequate daily intake of calcium-1000-150 mg.
Therapy for women with osteomalacia or lactating women is important for the health of mother and child. During uterine life, the child depends on vitamin D of the mother. Treatment of these patients is also taking vitamin D, however, lower doses are used to ensure lack of toxicity. Pregnant women should not receive vitamin A supplements in excess.
Side effects of therapy with vitamin D include:-Thirst, increased diuresis, reduced appetite-Nausea, vomiting, dizziness, headache.Prevention of osteomalacia and vitamin D deficiency:Lifestyle-modification by repeated exposure to the sun-Consumption of foods with high levels of vitamin D: fish, liver, sardines, egg, margarine, cerealsExposure to the sun for 15 minutes per day from April until September, with the hands, arms and face covered is sufficient.PrognosisAfter treatment the disease is very good. Most cases recover with therapy for osteomalacia with vitamin D. However it takes time for bones to recover. In untreated disease or prolonged risk of osteoporosis and fractures increases. Vitamin D is considered as therapy in some diseases such as cancer, heart disease and diabetes.