Bone softening - causes, symptoms and therapy

Bone softening: rickets and osteomalacia

If the bones are not sufficiently mineralized and as a result soft and deformable bones are formed, one speaks of rickets in babies and children and of osteomalacia in adults. The disease is associated with other, often rather uncharacteristic, symptoms and is mostly due to chronic vitamin D and calcium deficiency. If other possible underlying diseases can be excluded, a successful therapy is usually based on a balance of these deficiency symptoms. The onset of rickets has been greatly reduced by improved nutrition and the introduction of vitamin D prophylaxis for infants.

contents

• Bone softening: rickets and osteomalacia
• A short overview
• definition
• symptoms
• causes
• diagnosis
• treatment
• Naturopathic treatment

A short overview

The following overview provides a brief summary of the detailed information below on the clinical pictures of osteomalacia or rickets:

• definition: Bone softening is a systemic bone disease. In childhood it is referred to as rickets, later the term of osteomalacia is used. Inadequate mineralization of the bones in this disease leads to a soft and deformable bone substance.
• symptoms: Non-specific symptoms often occur in adults, such as dull bone pain and muscle weakness. Later skeletal deformations and often O- or X-legs occur in children. Rachitis manifests itself in addition to many other symptoms also disorders in bone and tooth formation and softened skull bones and rib swellings (rachitic rosary).
• causes: The main cause is a permanent shortage of vitamin D. This is associated with a reduced incorporation of calcium in the bones. Furthermore, other underlying diseases or metabolic and organ dysfunction may trigger the disease.
• diagnosisWhen the first signs of bone softening are detected, various blood levels are generally determined and X-ray examinations and skeletal scintigraphy performed. In addition, a measurement of bone density and optionally also a bone biopsy may be useful.
• treatment: If there are other underlying diseases, these are in the foreground during the treatment. If this is not the case, primarily the deficiency symptoms of vitamin D and calcium are treated in order to achieve remineralization of the bones. In addition to a healthy diet that ensures sufficient vitamin D and calcium, various naturopathic procedures can additionally support the healing process.

The serious consequence of insufficient mineralization of the bones is their softening and consequently their deformation, especially in areas of high stress. (Image: Double Brain / fotolia.com)

definition

Bone softening is a systemic disease of the bone skeleton. The disease occurs in childhood, it is referred to as rickets (also "English disease"). In adulthood one speaks of an osteomalacia. These two clinical pictures are assigned to the group of vitamin D deficiency diseases, as a prevailing vitamin D deficiency is the main cause. These deficiencies, or other metabolic and functional disorders, lead to inadequate mineralization of the bones, which then soften and become increasingly pliable and deformable. This is also the fundamental difference to osteoporosis, which does not result in a loss of bone substance strength, but in excessive bone mass depletion. To further delineate a general osteomalacia is a tumor-induced (oncogenic) osteomalacia.

Dietary rickets have become very rare due to improved care and nutrition of infants and toddlers, including vitamin D prophylaxis in the first year of life. However, as a result of other underlying diseases as triggers it still occurs, as well as occurring in older age osteomalacia.

symptoms

In addition to the symptoms of possible underlying diseases, osteomalacia manifests itself rather uncharacteristically in adults. Most commonly, the following symptoms occur:

• unspecific, dull bone pain,
• muscle weakness,
• fast fatigue,
• increasing curvature and deformation of the skeleton.

The mineralization disorder in the bones leads to fatigue and excessive demands on the entire skeleton and especially the heavily loaded areas such as the spine, hips and extremities. At an early stage of the disease, it is not uncommon for them to experience walking disorders, referred to as "waddling", which occur as a result of muscle weakness of the large gluteal muscle. Progressively it comes to bone bends, which can cause, for example, the formation of a hump, O-legs or X-legs (especially in children). As complication it comes also to so-called "fatigue fractures".

Typical bony symptoms are indicated by washed-out structures in the radiograph. Children often have O or X legs. (Image: Artemida-psy / fotolia.com)

Other typical symptoms in children with rickets include the following:

• insufficient tooth formation, enamel defects and caries formation,
• growth retardation,
• late closure of cranial sutures,
• Softening of cranial bones (craniotabes),
• visible rib swellings on the breastbone attachment between cartilage and bone (rachitic rosary).

In addition, especially in children, the nonspecific symptoms of increased irritability, dreadfulness and general restlessness as well as a flaccid musculature are observed. As a clear symptom in infants also shows a flabby abdominal wall ("frog abdomen"). In addition, constipation, seizures and excessive perspiration (head sweat) sometimes occur.

causes

In the bone metabolism process, vitamin D (calziferol) plays an important role in promoting calcium uptake from the intestines and kidneys, thus providing the necessary storage of calcium in the bones. Only in this way do the bones get the hardness and strength they need for everyday stress.

The main cause of osteomalacia and rickets is a demonstrable permanent deficiency of the bone-strengthening vitamin D, which in turn causes a calcium deficiency or a decreased incorporation of calcium into the bone. In the course of disease this leads to a reduced bone mineralization, whereby the bone substance then consists of an excessive proportion of soft bone matrix.

The most common cause of bone disease is chronic vitamin D deficiency, which may be due to lack of sun exposure to the skin, especially during the winter months. (Image: Ralf Geithe / fotolia.com)

An inadequate supply of vitamin D to the body is most commonly associated with a lack of light, since the UV-B radiation of sunlight is largely responsible for its formation. As a result, people who are veiled for religious reasons, for example, or who rarely spend time outside in daylight, are at particular risk. A vitamin D deficiency shows up in this country, especially in winter. In addition, people with a dark complexion who live in relatively low-light Northern Europe, an increased risk of disease, since they themselves can not produce the vitamin D in sufficient quantity.

In addition to reduced sun exposure but also metabolic or functional disorders of some organs as a trigger for bone softening come into question. If sufficient sun exposure is ensured, the skin, the liver, the intestine and the kidneys are involved primarily in the production of the so-called bone vitamin.

A possible disorder in the digestive tract is the syndrome of malassimilation, which prevents splitting and recycling of certain elements from the diet and is associated with softening of the bones. In addition to other underlying diseases also inflammatory bowel disease, renal dysfunction or liver cirrhosis are considered as causes. This mostly affects older people.

In children, among other things, the presence of rickets is associated with the congenital disorder called phosphate diabetes. In this hereditary disease, there is an increased excretion of phosphate and consequently low blood phosphate levels, which causes the mineralization disorders of the bones.

However, certain nutritional and enzyme deficiencies (for example, phosphatase deficiency), enzyme deficiencies, and certain anti-epileptic drugs are also associated with the deficiencies of vitamin D or calcium. In addition, mild symptoms of osteomalacia may occur during pregnancy and breastfeeding.

Various values ​​of a blood test can provide information about the presence of osteomalacia. (Image: Henrik Dolle / fotolia.com)

diagnosis

The first evidence of the presence of osteomalacia or rickets provides the general medical examination. The patient survey (anamnesis) should clarify whether there have already been cases of bone softening in the family.

By means of a blood test the disease becomes clear by different values. As a rule, increased evidence for the enzyme alkaline phosphatase and for the parathyroid hormone (parathyroid hormone). Most laboratory results show low vitamin D and calcium levels and, if necessary, decreased phosphate levels (kidney disease).

In order to better examine the bones and their structure and condition, procedures such as x-rays and skeletal scintigraphy are available. In the x-ray, the diseased, softened and deformed bones appear with a "washed-out" structure. The scintigraphy of the bones usually indicates increased bone metabolism. In addition, the low percentage of minerals in the bone matrix can be determined by measuring the bone density. Under certain circumstances, a bone biopsy from the iliac crest may be helpful for further diagnosis.

treatment

In general, timely diagnosed osteomalacia is considered treatable. The earlier the disease is detected, the less consequential damage is expected. If neither underlying cause diseases are known nor severe bone deformation has occurred, the primary goal of any therapy is the remineralization of the diseased bone substance. This is achieved primarily by a sufficient intake of vitamin D and calcium.

According to the Robert Koch Institute, every Northern European should provide a replenishment of vitamin D storage in the sunny months from spring to autumn. In this regard, the general recommendation for a daily outdoor stay is about 15 to 20 minutes. At least face and arms should be exposed to the sun unprotected. Whether enough vitamin D can be produced depends on various factors.

At the doctor's request, vitamin D supplements or injections may also be useful. In 2012, the German Nutrition Society raised its recommendation and is currently in favor of a daily intake of 20 μg of vitamin D or 10 μg in the first year of life. In addition to prophylaxis in the first year of life (or until the second winter in life) should therefore adolescents and adults appropriate amounts of vitamin D as a dietary supplement to take.

In principle, attention should be paid to a vitamin D and calcium rich diet. Important foods in this context are certain fish species, dairy products, eggs, various mushrooms, avocados, kale, broccoli, legumes, millet and whole grains. Even basic foods can have a positive effect.

If there are underlying diseases such as liver diseases, kidney diseases or intestinal diseases, these are therapeutically in the foreground. For example, phosphates and alkalizing substances are added during renal dysfunction.

Schuessler salts and other natural remedies can help to remineralise and strengthen the bones. (Image: Sonja Birkelbach / fotolia.com)

Naturopathic treatment

In particular, dysfunctions that lead to a decreased absorption of calcium through the intestinal mucosa and thus cause a bone softening, are considered in natural medicine. These include food intolerances, intestinal dysbiosis, leaky gut syndrome and fungal infections, which often cause each other.

Although it can not be expected that osteomalacia or rickets can only be treated with naturopathic therapies, various natural remedies offer promising support for the healing process. For example, light therapy (daylight lamp, UV-B lamp) is used or even homeopathy.

In addition, Schuessler salts are used, which stimulate different physical processes in conjunction with the vitamin D balance. In particular, the number one salts (calcium fluoratum) and number two (calcium phosphoricum) are used inter alia in bone softening and disorders in the bone formation process. Often, a combination of these two salts with the number eleven (Silicea) - a salt that regulates, inter alia, the calcium metabolism - used in osteomalacia and rickets. (jvs, cs; updated on 10.12.2018)

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