Rickets and osteomalacia

Abstract

In considering osteomalacia and rickets there are problems in their diagnosis, prevention and treatment. Although bone biopsy often demonstrates osteomalacia where it would be clinically unsuspected this is not a procedure which can be widely used, especially with the facilities of district hospitals. However it emphasizes the importance of looking diligently for osteomalacia in all situations where it is likely to occur, and of being fully aware of its clinical features. Although the main causes of nutritional osteomalacia are unlikely to alter rapidly, surgical practice may exchange one for another - for instance, the decline of ureterosigmoid anastomosis and the increase of jejuno-ileal bypass. The prevention of nutritional osteomalacia is not proving to be easy, since it appears difficult to get adequate dietary vitamin D to a significant number of those in the population who require it. A greater reliance on UVL would seem to be a more promising approach. It seems that neither skin pigmentation nor eating chapattis provides adequate explanations for the high incidence of rickets in the Asian or immigrant population. There are also some problems in the treatment of the established disorder. The management of renal glomerular osteodystrophy with 1α-hydroxylated vitamin D metabolites is not proving as simple as was hoped, but this is not surprising in view of the complexity of renal bone disease. However such metabolites may be unexpectedly useful in the osteomalacia of gastrointestinal disease. It is clear that future efforts should be made mainly in the field of prevention. However there is still room for the investigation of the effects of vitamin D deficiency in the human subject.