A bone-weakening condition, Osteomalacia refers to a condition in which new bone does not harden the way it should be forming. Also known as “bone softening”, the condition weakens bones and can cause them to break more easily. It occurs due to decreased mineralization, which results in bone breaking down faster than it can re-form. The condition is most commonly seen in adults.
Bone turnover occurs when the body reabsorbs the old tissue and forms new bone tissue – beginning with the softer inner layer that comprises collagen. During the process of mineralization, this inner layer normally becomes coated with minerals (that form a hard, outer shell). In people with osteomalacia, the shell does not form fully, leaving the collagen soft and vulnerable. If left untreated, the condition can worsen and lead to serious conditions like pseudofractures (also known as Looser’s zones) causing severe pain and turn into real breaks. Also, in children, osteomalacia and rickets often occur together, which can lead to bowing of the legs or premature tooth loss. Orthopedists or other specialists treating this condition can rely on medical billing companies to meet their claim submission tasks and thus receive reimbursement on time.
What Are the Causes and Symptoms of Osteomalacia?
A lack of vitamin D is the most common cause of osteomalacia. Vitamin D helps maintain calcium and phosphate levels that are essential in bone formation and maintaining bone health. These disorders can interfere with the body’s ability to absorb vitamins. Other related factors that can make it difficult for people to absorb Vitamin D include – diets (that are low in calcium), usage of certain medications (such as antacids, and some older antiepileptic drugs), lactose intolerance and surgeries to promote weight loss. Other additional causes include – digestive or kidney disorders, celiac disease, lack of phosphorus, liver disorders, and genetic factors.
Bone pain, bone fracture and muscle weakness are the common symptoms of osteomalacia. Muscle weakness occurs due to problems in the areas wherein the muscle attaches to the bone. A person with osteomalacia may face serious problems when walking or may develop a waddling gait. Other related symptoms include –
- Dull, aching pain in the legs, lower back, pelvis and ribs
- Weak, sore, and stiff muscles (especially in the trunk, shoulders, buttocks, and upper legs)
- Bones that can be sensitive to slight knocks
- Pseudofractures of weight-bearing bones, such as the feet and pelvis
In certain other cases, some individuals may not experience any specific symptoms.
How Is Osteomalacia Diagnosed and Treated?
Generally, the most common symptoms of osteomalacia (such as sore bones and muscles) are unclear enough that it can at times take 2-3 years to diagnose the condition. However, once an orthopedist suspects osteomalacia, they recommend performing several tests that can help them diagnose the condition in detail. A combination of diagnosis tests like – blood tests, bone mineral density tests and imaging tests may be performed as part of the diagnosis. A blood test confirms low levels of vitamin D, low levels of calcium and low levels of phosphorus, a strong indication of osteomalacia.
Physicians will also recommend testing of alkaline phosphatase isoenzymes as high level of these enzymes is a strong indicator of the condition. Blood tests may also be performed to check levels of parathyroid hormone as high levels of this hormone suggest insufficient vitamin D and other related problems. Bone mineral density scan may give important information about a patient’s bone health and may be helpful in evaluating the amount of calcium and other minerals present in a patient’s bone segment. Imaging tests like X-ray may be performed to identify small cracks (called Looser’s transformation zones) in the bones. In most cases, fractures can begin in these zones even with small injuries. Usually, an X-ray and blood tests are quite enough to make an accurate diagnosis. However, in certain rare cases, if any of these tests do not make a definite diagnosis, a bone biopsy may be performed.
Typically, treatment for this condition is quite effective, although it can take months for the bone strength to return in full. One of the important aspects of treatment of this bone disorder is to make sure that a person gets the levels of nutrients they need to support the bone mineralization process. If the condition is detected at an early stage, patients may need to consume oral supplements of vitamin D, calcium, or phosphate. In fact, this may be the first line of treatment if a person has absorption problems due to intestinal injury or surgery, or if they have a diet low in key nutrients. However, in certain rare cases, patients can take Vitamin D injections. Also, surgery may also be suggested as part of the treatment to correct bone deformities (in severe cases). Other treatment modalities to relieve or correct osteomalacia symptoms may include –
- Getting regular or adequate exposure to sunlight
- Stopping the habit of smoking, if a smoker
- Limiting the intake of alcohol
- Exercising regularly
- Eating a healthful diet rich in foods containing vitamin D and calcium
- Wearing braces to reduce or prevent bone irregularities
ICD-10 Codes for Osteomalacia
- M83 Adult osteomalacia
- M83.0 Puerperal osteomalacia
- M83.1 Senile osteomalacia
- M83.2 Adult osteomalacia due to malabsorption
- M83.3 Adult osteomalacia due to malnutrition
- M83.4 Aluminum bone disease
- M83.5 Other drug-induced osteomalacia in adults
- M83.8 Other adult osteomalacia
- M83.9 Adult osteomalacia, unspecified
Typically, treatment for this condition is quite effective, although it can take a considerable amount of time for bone strength to return in full. With successful treatment, osteomalacia can be eliminated and its effects can be completely healed within a modest period of time (usually several months).
Orthopedic medical billing and coding can be challenging. Medical billing and coding outsourcing is a great option for busy orthopedists as well as other specialists to get their claim submission tasks done with accurate codes.
Since joining our RCM Division in October 2021, Loralee, who is HIT Certified (Health Information Technology/Health Information Management), brings her extensive expertise in medical coding and Health Information Management practices to OSI.