Osteomalacia y Raquitismo

Descripción General

Definición

El raquitismo y la osteomalacia Osteomalacia Disorder caused by an interruption of the mineralization of organic bone matrix leading to bone softening, bone pain, and weakness. It is the adult form of rickets resulting from disruption of vitamin d; phosphorus; or calcium homeostasis. Osteomalacia and Rickets son trastornos de la disminución de la mineralización ósea. El raquitismo afecta al AL Amyloidosis tejido cartilaginoso de los LOS Neisseria cartílagos del crecimiento epifisarios en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria niños, mientras que la osteomalacia Osteomalacia Disorder caused by an interruption of the mineralization of organic bone matrix leading to bone softening, bone pain, and weakness. It is the adult form of rickets resulting from disruption of vitamin d; phosphorus; or calcium homeostasis. Osteomalacia and Rickets afecta a los LOS Neisseria lugares de recambio óseo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños y adultos.

Epidemiología

Raquitismo:

• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Estados Unidos, el raquitismo afecta sobre todo a los LOS Neisseria bebés que tienen:
  • Síndromes crónicos de malabsorción
  • Enfermedad renal
  • Que hayan sido alimentados exclusivamente con leche materna
    • Deficiencia de vitamina D
    • Afecta a los LOS Neisseria bebés de piel oscura
• La prevalencia a nivel mundial depende de:
  • Carencia nutricional
  • Falta de exposición al AL Amyloidosis sol

Osteomalacia Osteomalacia Disorder caused by an interruption of the mineralization of organic bone matrix leading to bone softening, bone pain, and weakness. It is the adult form of rickets resulting from disruption of vitamin d; phosphorus; or calcium homeostasis. Osteomalacia and Rickets:

• Se atribuye principalmente a la deficiencia de vitamina D
• La prevalencia está creciendo a nivel mundial.
• Afecta comúnmente a los LOS Neisseria adultos mayores aislados en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum casa
• Puede coexistir con el raquitismo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria niños

Etiología

El raquitismo y la osteomalacia Osteomalacia Disorder caused by an interruption of the mineralization of organic bone matrix leading to bone softening, bone pain, and weakness. It is the adult form of rickets resulting from disruption of vitamin d; phosphorus; or calcium homeostasis. Osteomalacia and Rickets pueden estar causados por deficiencias de vitamina D, calcio o fósforo. Estas afecciones pueden ser causadas por anomalías en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la deposición de la matriz ósea.

Relacionadas con la vitamina D (más comunes):

• Deficiencia de vitamina D:
  • Escasez alimentaria
  • Falta de luz solar
• Malabsorción de la vitamina D:
  • Posgastrectomía
  • Bypass gástrico
  • Enfermedad celíaca
  • Insuficiencia pancreática
  • Tratamiento con colestiramina
  • Abuso de laxantes
• Alteración de la 1-hidroxilasa de la 25-hidroxivitamina D:
  • Raquitismo dependiente de la vitamina D tipo 1
  • Hipofosfatemia ligada al AL Amyloidosis X
  • Osteomalacia Osteomalacia Disorder caused by an interruption of the mineralization of organic bone matrix leading to bone softening, bone pain, and weakness. It is the adult form of rickets resulting from disruption of vitamin d; phosphorus; or calcium homeostasis. Osteomalacia and Rickets oncogénica
• Respuesta alterada de los LOS Neisseria órganos diana a la D3: raquitismo dependiente de la vitamina D tipo II

Relacionados con la hipofosfatemia:

• Hipofosfatemia ligada al AL Amyloidosis X
• Displasia fibrosa
• Osteomalacia Osteomalacia Disorder caused by an interruption of the mineralization of organic bone matrix leading to bone softening, bone pain, and weakness. It is the adult form of rickets resulting from disruption of vitamin d; phosphorus; or calcium homeostasis. Osteomalacia and Rickets causada por antiácidos
• Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica crónica
• Tenofovir Tenofovir An adenine analog reverse transcriptase inhibitor with antiviral activity against HIV-1 and hepatitis b. It is used to treat HIV infections and chronic hepatitis b, in combination with other antiviral agents, due to the emergence of antiviral drug resistance when it is used alone. Anti-HIV Drugs
• Cadmio
• Paraproteinemia

Inhibidores de la mineralización:

• Etidronato
• Fluoruro
• Aluminio
• Hierro

Misceláneos:

• Hipofosfatasia
• Osteomalacia Osteomalacia Disorder caused by an interruption of the mineralization of organic bone matrix leading to bone softening, bone pain, and weakness. It is the adult form of rickets resulting from disruption of vitamin d; phosphorus; or calcium homeostasis. Osteomalacia and Rickets axial Axial Computed Tomography (CT)
• Fibrogénesis imperfecta ósea

Fisiopatología

Raquitismo

• El grosor de la placa de crecimiento se determina por:
  • La proliferación e hipertrofia de los LOS Neisseria condrocitos
  • Invasión vascular del cartílago de crecimiento
• La invasión vascular requiere la mineralización del cartílago de crecimiento.
• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum ausencia de la mineralización, el cartílago de crecimiento se acumula y se desorganiza, ocasionando que la placa de crecimiento se engrose.
• La acumulación de osteoide no mineralizado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la metáfisis (justo debajo del cartílago de crecimiento) acaba provocando el arqueamiento y deformación de los LOS Neisseria huesos.

Osteomalacia Osteomalacia Disorder caused by an interruption of the mineralization of organic bone matrix leading to bone softening, bone pain, and weakness. It is the adult form of rickets resulting from disruption of vitamin d; phosphorus; or calcium homeostasis. Osteomalacia and Rickets

• Normalmente, el 7% de la superficie ósea se está remodelando activamente.
• Los LOS Neisseria osteoclastos reabsorben el hueso antiguo mientras que los LOS Neisseria osteoblastos depositan nuevo osteoide (matriz orgánica).
• La osteomalacia Osteomalacia Disorder caused by an interruption of the mineralization of organic bone matrix leading to bone softening, bone pain, and weakness. It is the adult form of rickets resulting from disruption of vitamin d; phosphorus; or calcium homeostasis. Osteomalacia and Rickets puede ocurrir si:
  • El nuevo osteoide es cualitativa o cuantitativamente anormal
  • El calcio y el fosfato son insuficientes en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el líquido extracelular
  • Existe acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el lugar de la calcificación (enfermedad renal)
  • Existe una actividad inadecuada de la fosfatasa alcalina
  • La calcificación está influenciada por fármacos (e.g., aluminio, fluoruro)

Presentación Clínica

Raquitismo

• Retraso en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cierre de las fontanelas y de los LOS Neisseria huesos del cráneo (craneotabes)
• Protuberancias parietales y frontales
• Genu varum Genu varum Genu varum is a deformation of the knee joint(s) that creates angulation of the lower limb(s) away from the midline in the coronal plane. Children ages 1-5 years are commonly affected. Genu Varum (niños pequeños) y Genu valgum Genu valgum Genu valgum is a deformation of the knee joint(s) that creates angulation of the lower limb(s) toward the midline in the coronal plane. Children ages 1-5 years are commonly affected. Genu Valgum (niños mayores)
• Deformación de la columna vertebral (cifoescoliosis)
• Surco en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el margen inferior del tórax conocido como Surco de Harrison
• Deformación principalmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria huesos largos y ensanchamiento de la muñeca
• Ampliación de las uniones costocondrales con “bordes densos en las costillas” (rosario raquítico)
• Problemas con la arquitectura dental
• Fracturas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum tallo verde (fracturas lineales con periostio intacto)
• Baja estatura

Osteomalacia Osteomalacia Disorder caused by an interruption of the mineralization of organic bone matrix leading to bone softening, bone pain, and weakness. It is the adult form of rickets resulting from disruption of vitamin d; phosphorus; or calcium homeostasis. Osteomalacia and Rickets

• Fatiga
• Dolor Dolor Inflammation óseo difuso
• Debilidad muscular
• Fracturas patológicas
• Dificultad para caminar/marcha de pato
• También puede presentarse con signos de hipocalcemia si se asocia a una deficiencia de calcio

Diagnóstico y Tratamiento

Diagnóstico

Historia clínica:

• Fracturas
• Dolor Dolor Inflammation óseo
• Historia familiar
• Desnutrición
• Estilo de vida restringido a la casa
• Falta de exposición al AL Amyloidosis sol

Examen físico: Deformidades esqueléticas típicas del raquitismo

Estudios de laboratorio:

• Los LOS Neisseria valores de laboratorio varían en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum función de las deficiencias subyacentes.
• Raquitismo calcipénico:
  • ↑ Hormona paratiroidea (PTH, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)
  • ↓ Calcio
  • ↓ Fosfato
• Raquitismo fosfopénico:
  • PTH normal o ligeramente elevada
  • ↓ Fosfato
• ↓ Vitamina D ( en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la deficiencia de vitamina D)
• ↑ Niveles de fosfatasa alcalina (excepto en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la hipofosfatasia)

Imágenes de rayos X:

• Raquitismo:
  • Ensanchamiento epifisario
  • Metáfisis deshilachadas/ahuecadas
  • Genu varum Genu varum Genu varum is a deformation of the knee joint(s) that creates angulation of the lower limb(s) away from the midline in the coronal plane. Children ages 1-5 years are commonly affected. Genu Varum o valgum (arqueamiento de los LOS Neisseria huesos largos)
  • Rosario raquítico
  • Craneotabes
• Osteomalacia Osteomalacia Disorder caused by an interruption of the mineralization of organic bone matrix leading to bone softening, bone pain, and weakness. It is the adult form of rickets resulting from disruption of vitamin d; phosphorus; or calcium homeostasis. Osteomalacia and Rickets:
  • Osteopenia Osteopenia Osteoporosis
  • Pseudofracturas, una banda de material óseo de menor densidad

Tratamiento

• Suplementación con vitamina D
• Dieta rica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum calcio; suplementos de calcio y fosfato
• Exposición adecuada a la luz solar
• La mayoría de las deformidades del raquitismo se corrigen con el tratamiento.
• Si se han producido deformidades graves, a veces es necesaria una corrección ortopédica.

Diagnóstico Diferencial

• Hiperparatiroidismo: los LOS Neisseria niveles de PTH patológicamente elevados se resumen en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el término hiperparatiroidismo. Según la patogénesis, se pueden distinguir 3 formas: hiperparatiroidismo primario, secundario y terciario. El hiperparatiroidismo de larga data puede provocar osteopenia Osteopenia Osteoporosis y fracturas óseas patológicas. El enfoque del tratamiento depende de la causa subyacente e incluye la paratiroidectomía para el hiperparatiroidismo primario.
• Enfermedad renal crónica: se define como una disminución irreversible no solo de la función glomerular y tubular, sino también de la función renal endocrina. Esta condición se presenta como una función renal excretora e incremental patológicamente alterada. La enfermedad renal crónica puede causar hipocalcemia por la disminución de la formación de vitamina D activa, lo que a su vez provoca un hiperparatiroidismo secundario y una disminución del calcio de los LOS Neisseria huesos. El tratamiento es principalmente de soporte.
• Enfermedad de Blount: problema ortopédico pediátrico en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el que la pierna está arqueada hacia fuera o en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum posición varus. Esta enfermedad se debe a un crecimiento disfuncional de la cara posterior medial de la epífisis proximal de la tibia Tibia The second longest bone of the skeleton. It is located on the medial side of the lower leg, articulating with the fibula laterally, the talus distally, and the femur proximally. Knee Joint: Anatomy dando como resultado una deformidad del miembro inferior. El diagnóstico se establece con el cuadro clínico y los LOS Neisseria estudios de imagen, y el tratamiento consiste en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el uso de aparatos ortopédicos y, a veces, en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la corrección quirúrgica.
• Acondroplasia: trastorno genético que provoca enanismo. En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum quienes padecen esta enfermedad, los LOS Neisseria brazos y las piernas son cortos, mientras que el torso suele tener una longitud normal. Los LOS Neisseria afectados tienen una altura adulta media de 131 cm (4 pies 4 pulgadas) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria hombres y de 123 cm (4 pies) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las mujeres. El diagnóstico se establece clínicamente y se confirma mediante pruebas genéticas. El tratamiento es principalmente de apoyo.
• Osteoporosis Osteoporosis Osteoporosis refers to a decrease in bone mass and density leading to an increased number of fractures. There are 2 forms of osteoporosis: primary, which is commonly postmenopausal or senile; and secondary, which is a manifestation of immobilization, underlying medical disorders, or long-term use of certain medications. Osteoporosis: pérdida de masa ósea asociada generalmente al AL Amyloidosis envejecimiento y a los LOS Neisseria déficits hormonales. Más frecuente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum mujeres posmenopáusicas. Presentan fracturas por fragilidad. El diagnóstico se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cuadro clínico y en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la medición de la densidad mineral ósea. El tratamiento consiste en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la administración de suplementos de vitamina D, calcio y bifosfonatos.
• Osteogénesis imperfecta: un trastorno genético asociado a una extrema fragilidad ósea. La enfermedad varía en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum gravedad, pero suele presentarse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la infancia temprana con múltiples fracturas y deformidades óseas. La osteogénesis imperfecta se diagnostica clínicamente y con pruebas genéticas. El tratamiento incluye bifosfonatos y se centra principalmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la prevención de fracturas.