Osteomalacia hypoparathyroidism

Contraindications Primary or secondary hyperparathyroidism, including hypercalci-uria (renal calcium leak), hypomagnesemic states (serum magnesium less than 1.5 mg/dl), bone disease (osteoporosis, osteomalacia, osteitis), hypocalcemic states (e.g., hypoparathyroidism, intestinal malabsorption), normal or low intestinal absorption and renal excretion of calcium, enteric hyperoxaluria, and patients with high fasting urinary calcium or hypophosphatemia. 

Hypoparathyroidism PO 625 mcg-5 mg/day (with calcium supplements). Nutritional rickets, osteomalacia PO 25-125 meg/day for 8-12 wk. Those with malabsorption syndrome. 250-7,500 meg/day. 

It is indicated in osteoporosis, hypoparathyroidism, hyperparathyroidism (with bone disease), renal osteodystrophy, nutritional and malabsorptive rickets, hypophosphataemic vitamin D resistant rickets and osteomalacia. 

As a brief introductory summary, vitamin D substances perform the following fundamental physiological functions (1) promote normal growth (via bone growth) (2) enhance calcium and phosphorus absorption from the intestine (3) serve to prevent rickets (4) increase tubular phosphorus reabsorpiion (5) increase citrate blood levels (6) maintain and activate alkaline phosphatase m bone (7) maintain serum calcium and phosphorus levels. A deficiency of D substances may be manifested in the form of rickets, osteomalacia, and hypoparathyroidism. Vitamin D substances are required by vertebrates, who synthesize these substances in the skin when under ultraviolet radiation, Animals requiring exogenous sources include infant vertebrates and deficient adult vertebrates, Included there are vitamin D (calciferol ergocalciferol) and vitamin D< (activated 7-dehydrocholesterol cholecalciferol). 

Calcium preparations are often administered to ensure that adequate calcium levels are available in the body for various physiologic needs, including bone formation. Specifically, calcium supplements can be used to help prevent bone loss in conditions such as osteoporosis, osteomalacia, rickets, and hypoparathyroidism. For instance, calcium supplements alone cannot prevent osteoporosis in postmenopausal... 

Calcium supplements Calcium carbonate (BioCal, Os-Cal 500, Turns, others) Calcium citrate (Citracal) Calcium glubionate (Calcionate, Neo-Calglucon) Calcium gluconate Calcium lactate Dibasic calcium phosphate Tribasic calcium phosphate (Posture) Provide an additional source of calcium to prevent calcium depletion and encourage bone formation in conditions such as osteoporosis, osteomalacia, rickets, and hypoparathyroidism... 

Hypoparathyroidism manifestates as osteomalacia with a low number and activity of both osteoclasts and osteoblasts. Osteoid formation is reduced, and its... 

Hypercalcemia persists for many months after the cessation of excessive intakes of vitamin D, because of the accumulation of the vitamin in adipose tissue and its slow release into the circulation. The introduction of calcitriol and 1 a -hydroxycalcidiol for the treatment of such conditions as hypoparathyroidism, renal osteodystrophy, hypophosphatemic osteomalacia, and vitamin D-dependent rickets has meant that hypercalcemia is less of a problem than when high doses of vitamin D were used in the treatment of these conditions. Because calcitriol has a short half-life in the circulation, the resultant hypercalcemia is of shorter duration than after cholecalciferol, and adjustment of the dose is easier. 

Indications for vitamin D are the prevention and cure of rickets of all kinds and osteomalacia, and the symptomatic treatment of some cases of hypoparathyroidism also psoriasis. 

Kidneys Dysfunction of the proximal tubule may occur as a late manifestation of Wilson s disease. Epithelial flattening, a loss of the brush-border membrane, mitochondrial anomalies and fatty cellular changes can be observed. These findings are, in turn, responsible for proteinuria with a predominance of hyperaminoaciduria (L. UzMAN et al., 1948). Enhanced calciuria and phosphat-uria may cause osteomalacia as well as hypoparathyroidism. (329, 344) Glucosuria and uricosuria, if present, are without clinical relevance. Due to decreased bicarbonate resorption, tubular acidosis may occur, with a tendency towards osteomalacia as well as the development of nephrocalcinosis and renal stones (in some 15% of cases). (344, 356, 392) The intensity of the copper deposits in the kidneys correlates closely with the cellular changes and functional disorders. The glomerular function is not compromised, with the result that substances normally excreted in the urine are not retained. 

Osteomalacia may develop if long-term administration of ketoconazole is used hypoparathyroidism has developed... 

It has been known for 40 years (H13) that rickets develops in children when the plasma [Ca] [P] product falls below about 30, and is either absent or healing when the plasma product exceeds 40. In adults the critical value of the product is about 20, below which level osteomalacia results. There are, however, exceptions to these general rules and, in particular, osteomalacia has been described in a case of postoperative hypoparathyroidism in which the plasma calcium was low but the plasma phosphate correspondingly high. The [Ca] [P] product in this case was... 

Calcitriol is a highly potent vitamin D3 analog (see Figure) used in the therapy of secondary hypoparathyroidism and osteomalacia. 

The advances in our understanding of vitamin D3 metabolism which have been described in the previous sections have promoted the rapid use of some of these compounds in the clinic. Both la-hydroxyvitamin D3 and la,25-dihydroxyvitamin D3 have been studied in several disease states, such as chronic renal failure 28, 32, 33, 51, 71, 115, 144), hypoparathyroidism 74, 159), osteomalacia 23, 87), osteoporosis 106), and neonatal hypocalcemia 47,96). 

Prophylaxis of rickets Hypoparathyroidism Adult osteomalacia Acute Anorexia, nausea, vomiting, diarrhea, headache, polyuria, polydipsia. Chronic Weight loss, pallor constipation, fever, hypercalcemia, calcium deposits in soft tissues. ... 

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