OSTEOMALACIA

ASTHI-VAKARATAA -- RICKETS -- OSTEOMALACIA

WHAT IS THIS DISORDER?

ASTHIVAKARATAA or rickets in children and Osteomalacia in adults is a group of disorders in which there is softening and weakening of the bones. When it is in children, it is called Rickets and usually present with bending of the bones of the legs inward or outward, and when it is in adults, it presents with severe bone pains.

WHY THIS APPEARS IN THE BODY?

For the proper growth and maintenance of bones we need calcium and phosphorus in normal amounts. We get all this calcium and phosphorus from the diet but our body cannot absorb these from the intestines. Our body needs a group of substances known as Vitamin D. vitamin D helps in the absorption of calcium and phosphorus, Vitamin D is also activated into some of its active compounds with the help of sunlight when there is direct exposure of sunlight.

Any condition which results in the deficiency of these can result into ASTHIVAKARTAA ---

LACK OF VITAMIN D—

--very less exposure to sunlight

--in children who always stay inside

--in persons who have to work indoors always

--children who have lactose intolerance—have trouble digesting milk, cannot get vitamin D

--children who don’t drink milk products at all

--if children are only on breastfeed, human breastfeed doesn’t contain much vitamin D

--disorders that reduce the digestion and absorption of fats from the intestines cause a lack of vitamin D

LACK OF CALCIUM AND PHOSPHORUS—

--not getting enough of these from the diet

--when due to genetic reasons our kidneys hold back phosphorus, and there is a loss of it through kidneys

--sometimes severe diarhoea and vomiting can cause loss of these from the body

--overactive resorption (taking out the calcium from the bones) due to the overactive thyroid gland

VARIOUS CAUSES IN ADULTS WHICH RESULT IN LACK OF VITAMIN D—

--renal tubular acidosis

--malnutrition during pregnancy

--malabsorption syndrome

--hypophosphotamia

--chronic renal failure

--long term anticonvulsant therapy

--coeliac disease- GRAHNI ROGA

ASTHI KSHYA LAKSHAN – SUSHRUTA  SUTRA 15, CHARAK SUTRA 17,67

—DANTA, NAKHA, ROMA, LOMA, KESHA PAATAN, ASTHI TODA (pricking pain in bones), KESH RUKSHTA, DEH RUKSHATA, PAINS IN THE BODY, MAANS ABHILASHA, ASTHI BADHATAA        LIKE FEELING, FATIGUE, WEAKNESS AND LOOSENESS OF THE JOINTS

ASTHIVAHA SROTODUSHTI---CHARAK SUTRA 28/16

--Adhyasthi (extra bone growing over the bone)

--Adhidantau (extra teeth growing)  

--dant Asthibheda (pain in the teeth and bone) shoola (pains), vivarnataa (changes in the color of the skin in various parts)

--kesha (long hair) loma (small hair) nakha (nails) shmashru (beard) doshashch Asthi pradoshajah.

 WHAT ARE ITS SIGNS AND SYMPTOMS??

ASTHI VAKARTAA IN CHILDREN OR RICKETS---

                --bone tenderness in various parts of the body

                --Dental problems—delayed formation of teeth, defects in the structure of teeth, holes in the enamel, increased cavities in the teeth

                --muscle weakness – Richetal myopathy

                --increased tendency for fractures

                --skeletal deformities like bowed legs (Genu Varum), knock knees (Genu Valgum), cranial deformitis (skull bossing), spinal deformitis

                --stunted growth, short stature

                --Hypocalcemia( low calcium level in the blood)

                --Tetany – uncontrolled muscle spasms all over the body

                --soft skull (craniotabes)

                --costochondral swelling—ricketal rosary

                --Harrisons groove – a horizontral groove along the lower border of the thorax corresponding to cosatal insertion of diaphragm

                --widening of wrists

                --breast bone pushed forward (pigeon shaped chest)

ASTHIVAKARATAA IN ADULTS OR OSTEOMALACIA—

                --bone pains, bone tenderness, weakness in the bones, muscle weakness

                --easy fractures, bending of bones, softening of bones, pelvic flattening

                --numbness around the mouth, numbness in the arms and the legs, spasms in the hands and the feet

                --starts insidiously as aches and pains in the lumber region and thighs, pain is symmetrical and non radiating

                --there is difficulty in climbing up the stairs and standing from the sitting position

                --the typical waddling gait

                --chronic fatigue is an important feature many a times

HOW IT IS DIAGNOZED?

INVESTIGATIONS—

-low serum calcium

-low urinary calcium

-sometimes low serum phosphate

-low levels of vitamin D

-Bone x rays

-Bone density test

TREATMENT SHCHEDULE—

Advice for AsthiDusht`ee (or Vriddhi)

Panchakarma (Vamana, Virechana, Nasya, Basti, Raktamokshan`a)

Basti: (Tikta Rasa PradhaanaDravya siddha Ghrita/Ksheera)

Advice for AsthiKshaya:

--Guru, Kathina, Khara, PaarthivaDravya – aushadha and ahaara

-- Tikta Rasa yukta herbs and ahaara

--herbs with SandhaneeyaGuna like ARJUNA, GUGGULU, MOTHA, LAKSHA

--Dravya (Single Drugs): Pooga, Naareekela, Pravaala, MrigaS`hringa, S`hauktika, SudhaaVarga, Vaataama, Methikaa, Majjaa

--Formulations - Tiktadravya siddha Ghrita, Taila, TiktaKsheeraBasti, Chyavanpraasha,

--Aahaara (Diet)-Godugdha, Ghrita, Maamsa Rasa

Chikitsaa Karma - Basti (Tikta Rasa PradhaanaDravya siddha Ghrita/Ksheera)

RASAYANA—

ATHI MAJJA POSHAK – MOTHA, GOKHRU, GILOY, AMLA

DR PAWAN MADAAN

drmadaan@gmail.com

+919530959828