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strength to reduce the risk of fractures and to be as independent as possible. Many people with severe forms of osteogenesis imperfecta must have surgery to strengthen their bones, dental and orthodontic procedures to correct and improve the appearance of their teeth, and physical therapy to enhance movement. In a surgical procedure called rodding, a metal rod is inserted through the length of the long bones to strengthen them and prevent or correct deformities. People with severe disability often must use wheelchairs, braces, or other mobility aids.

If you have osteogenesis imperfecta, exercise as much as possible (walking and swimming are good choices). Exercise strengthens your muscles and bones and helps you avoid fractures. Ask your doctor about other safe and appropriate exercises. Maintain a healthy weight, eat a nutritious diet, and don’t smoke. An excessive intake of alcohol, caffeine, or corticosteroid medications can deplete bones and make them more fragile.

Osteomalacia

Osteomalacia, also called adult rickets, is softening and weakening of the bones. Osteomalacia results from the body’s inability to absorb calcium or to deposit mineral salts on the protein structure of bone, usually because of a deficiency of vitamin D. Without vitamin D, the body cannot absorb calcium and phosphorus from food. Both calcium and phosphorus are required for healthy bone growth, strength, and maintenance. Osteomalacia is rare in the United States.

The elderly, people in nursing homes, people who have darker skin (melanin blocks the action of ultraviolet light from the sun in the skin and interferes with the skin’s ability to make vitamin D), people who have lactose intolerance (see page 770), or people who drink large amounts of alcohol are at risk of vitamin D deficiency. Vitamin D deficiency can sometimes result from chronic kidney failure (see page 817) or a condition such as celiac disease (see page 768) that interferes with the absorption of nutrients.

Symptoms

The symptoms of a vitamin D deficiency, such as bone pain and tenderness, can be mistaken for the symptoms of rheumatoid arthritis (see page 918). Other symptoms include muscle cramps, tingling, and weakness. You may feel tired and stiff and find it difficult to stand. In more severe cases, weakened bones may break easily.

Diagnosis

If you have symptoms of osteomalacia, your doctor may recommend blood and urine tests, X-rays, and possibly a biopsy (in which samples of cells are removed and examined under a microscope). Osteomalacia is much less common than osteoporosis but, because the two conditions look identical on X-rays, a biopsy is the only way to make an accurate diagnosis.

Treatment

If you have osteomalacia, your doctor will probably prescribe a vitamin D supplement and treat any underlying disease that is contributing to the problem. You can also get vitamin D from fortified milk, cereal, egg yolks, liver, and fatty fish (such as tuna, mackerel, or salmon) and by exposing your skin to moderate amounts of sunlight.

Paget’s Disease of the Bone

In Paget’s disease of the bone, also called osteitis deformans, the normal process of bone breakdown and formation is disturbed. Paget’s disease causes an increase in the rate at which bone breaks down and causes abnormal bone to form in its place. This new bone, although thicker and larger than the healthy bone, is weaker and more fragile.

Paget’s disease can occur in part or all of one or many bones; the hip and the tibia (the inner, thicker bone in the lower leg) are the most common sites. The thighbone, skull, spine, and collarbone are also frequently affected. Men seem to develop Paget’s disease more often than women. For unknown reasons, Paget’s disease is more common in some geographic areas than in others. Doctors think that a virus may be responsible because viruslike particles have been found in some bone cells of affected people.

Symptoms

Although Paget’s disease of the bone does not always produce symptoms, the most common symptom is constant bone pain that is worse at night. Affected