Bone disorders due to malformation or loss of mineral density is rampant in India.
Osteoporosis is a common ailment among Indians, but yet another pervasive defect of bones, Osteomalacia doesn’t find much reference, despite been widespread among people of all ages, says Dr. Rajeev K Sharma, Senior Consultant, Orthopedics and Joint Replacement Surgeon, Indraprastha Apollo Hospital, New Delhi. In a free-wheeling chat with Jayashankar Menon, Dr. Sharma speaks in length about the disease and its impact. Excerpts:
JM: What is Osteomalacia?
RKS: Osteomalacia is softening of bones due to malformation resulting rom a deficient bone building process. While Osteoporosis affects and weakens previously well-built bones, Osteomalacia is a defect of bone formation.
JM: What are the common causes of Osteomalacia?
RKS: Sensation in your bones or a feeling of extreme weakness in the muscles, particularly those that support the bones? Have you started experiencing difficulty in walking or climbing stairs because of a growing weakness in the legs? If yes, you should immediately get a bone examination done for yourself.
Osteomalacia occurs when bones do not get the required nutrients and building blocks as they are developing. Most common cause is the body’s inability to absorb calcium and other minerals and process them into bone formation. Vitamin D is an important nutrient that enables the body to absorb calcium and maintain calcium and phosphate levels for proper bone formation. When the body lacks vitamin D, it affects bone formation resulting in defective bone, soft and ill formed bone that is extremely prone to fractures.
JM: How does deficiency of Vitamin D translate affect the bones?
RKS: Deficiency of vitamin D translates into body’s inability to process calcium for use in bones to give them structural strength. When bones grow soft, they may also bend into undesirable shapes, even causing disability. Osteomalacia is widely prevalent in India due to vitamin D deficiency.
This may seem strange since India is a sun abundant country and the sun is the main source of vitamin D. When you skin is exposed to the sun, it process vitamin D which then is utilized by the body in multiple functions. But, a minimum of 15-30 minutes of exposure is needed on a regular basis to make this happen. However, lack of sun exposure is a major worry in India. Most people, including the elderly, stay indoors. The Indian way of dressing is another factor. Indians mostly wear clothes that cover the entire body, leaving little or no skin exposed to the sun.
In fact, a large number of women in rural areas even cover their heads and faces. At the same time, a large number of young in urban India who step out apply sunscreens liberally, again preventing sun exposure. All these factors make Indians more susceptible to osteomalacia due to vitamin D deficiency.
JM: Who else can have Vitamin D absorption that can be a problem?
RKS: In people, who have had any surgery to remove a part of the small intestine, vitamin D absorption can be a problem. Some kidney and liver disorders can also interfere with the body’s ability to absorb vitamin D. A diet lacking in phosphates can cause phosphate depletion. This can also lead to osteomalacia as phosphates are also important bone minerals. Sometimes, medication to treat seizures and other brain issues, can also cause osteomalacia.
JM: What are the symptoms of Osteomalacia?
In the initial stage of Osteomalacia, there might actually be no apparent symptom. But, as the disease progresses and bones become soft and weak, one may start experiencing muscle weakness ad bone pain. Muscle weakness or a feeling that your muscles will not be able to support your body and bones is a common symptom
Pain in the bones, especially in the bones that carry more weight is another symptom. Pain is often experienced in pelvic area, lower back, or the legs. Difficulty in walking, climbing stairs or rising from a chair without support, decreased muscle tone, leg weakness, bones that are achy and susceptible to fractures.
JM: How to diagnose Osteomalacia? What is the kind of treatment that is available in India?
RKS: Osteomalacia can be easily diagnosed with an X-Ray and some other diagnostic tests. Blood tests to check for levels of vitamin D, calcium, and phosphorus in the blood can also detect the disorder. It can be treated too by quickly supplementing the body with vitamin D, calcium and other minerals that are needed to strengthen the bones. In most cases oral intake of supplements helps, but in some cases, vitamin D injections may be needed or even intravenous doses of vitamin D. In children who have suffered from bone malformation and distorted muscoskeletal system, there recovery will have to be aided with the use of braces to correct the deformation of the bone. However, a large number of cases of Osteomalacia can be prevented if there is sufficient awareness about the need for vitamin D intake and sun exposure.