Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- older age
- vitamin D and calcium deficient diets
- lack of sunlight exposure
- fractures
- malabsorption syndromes
- diffuse bone pain and tenderness
- proximal muscle weakness
- family history of osteomalacia
- waddling gait
Outros fatores diagnósticos
- anticonvulsant therapy
- steatorrhea
Fatores de risco
- dietary calcium and vitamin D deficiency
- limited sunlight exposure
- chronic kidney disease
- inherited disorders of vitamin D and bone metabolism
- hypophosphatasia
- anticonvulsant therapy
- mesenchymal tumors
- Fanconi syndrome
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- serum calcium level
- serum 25-hydroxyvitamin D level
- serum phosphate level
- serum BUN and creatinine
- intact PTH
- serum alkaline phosphatase
- 24-hour urinary calcium
Investigações a serem consideradas
- bone x-rays
- 24-hour urinary phosphate
- dual-energy x-ray absorptiometry
- iliac crest biopsy with double tetracycline labeling
Algoritmo de tratamento
vitamin D deficient
inherited or acquired disorders of phosphate wasting
Colaboradores
Autores
Bridget Sinnott, MD

Professor of Medicine
Medical College Georgia
Augusta
GA
Declarações
BS declares that she has no competing interests.
Agradecimentos
Dr Bridget Sinnott would like to gratefully acknowledge Dr Jelena Kravarusic, a previous contributor to this topic. JK declares that she has no competing interests.
Revisores
Udaya Kabadi, MD, FRCP(C), FACP, FACE
Director
Endocrinology
Department of Internal Medicine
VA Medical Center
University of Iowa
Iowa City
IA
Declarações
UK declares that he has no competing interests.
Stephan Scharla, MD
Department of Internal Medicine
Endocrinology & Diabetes
LMU University Munich
Munich
Germany
Declarações
None declared.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
Holick MF, Brinkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911-1930.Texto completo Resumo
Cystic Fibrosis Trust. European cystic fibrosis bone mineralisation guidelines. Feb 2011 [internet publication].Texto completo Resumo
Munns CF, Shaw N, Kiely M, et al. Global consensus recommendations on prevention and management of nutritional rickets. 2016 Feb;101(2):394-415.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Osteoporosis
- Paget disease
Mais Diagnósticos diferenciaisGuías de práctica clínica
- Global consensus recommendations on prevention and management of nutritional rickets
- Dietary reference intakes for calcium and vitamin D
Mais Guías de práctica clínicaInicie sesión o suscríbase para acceder a todo el BMJ Best Practice
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