Pseudo- fractures caused by osteomalacia are referred to as Milkman’s syndrome. Pseudo-fractures are features that appear in radiological examinations and appear white and band-like in the X-ray images.
What is Milkman Syndrome?
The pseudo-fractures of Milkman’s syndrome are not real fractures, but pathological remodeling processes in the bones, which are mostly due to osteomalacia or a similar bone disease. They were given by Dr. Emil Looser discovered and described and are therefore also referred to as Looser conversion processes. The symptoms were diagnosed by Dr. Milkman in 1930 and is therefore also called Milkman syndrome. See AbbreviationFinder for abbreviations related to Milkman Syndrome.
Milkman syndrome occurs most commonly in women between the ages of 40 and 70 and is caused by a lack of bone density. The lack of density arises as an expression of demineralization in the bone. In addition, compressions occur below and above the pseudofracture. Crescent-shaped calcifications, i.e. calcium deposits, can be observed on the substantia compacta (the outermost layer of bone under the periosteum) and show up as a deformation on the periosteum (the periosteum).
The pseudo-fractures are mostly symmetrical and appear in advanced stages of various bone diseases such as osteomalacia. Pseudo- fractures can be observed particularly on the hip bone (Os coxae), the ulna of the forearm (ulnar), the thigh bone (femur) and the shoulder blade (scapula).
Milkman syndrome occurs in bone diseases such as osteomalacia or rickets. The trigger for the syndrome as well as the diseases is mostly a lack of vitamin D3 household. Vitamin D3 is responsible for both the transport and the biologically meaningful integration of calcium. A deficiency symptom can therefore become apparent through the Looser conversion processes in radiological examinations.
The looser remodeling processes are brought about by excessive activation of osteoblasts and osteoclasts. The vitamin D3 deficiency and the resulting calcium deficiency stimulate the parathyroid glands to secrete the parathyroid hormone. This stimulates the production of vitamin D3 in the kidneys and the absorption of calcium in the intestine.
But it also activates the bone cells at the same time. Due to the excessive activation of osteoblasts and osteoclasts, bone material is both broken down and remodeled. Since a balanced vitamin D3 household depends on several influences inside and outside the body, a deficiency can be caused by several factors.
Vitamin D is first formed in the lower skin layers of the epidermis through exposure to sunlight. This can lead to complications. Little exposure to the sun means low vitamin D production and promotes bone diseases such as osteomalacia or osteoporosis. However, about three quarters of an hour is already sufficient to compensate for potential deficiencies.
Another important factor in addition to sun exposure is the effective absorption of UV-B radiation by the skin. If the skin suffers from serious damage such as severe burns, inflammation, necrosis, sufficient activation of vitamin D cannot be guaranteed. Skin and vitamin D production form a form of counter-conditionality here.
Since the keratinocytes of the skin cannot produce healthy skin cells without vitamin D and vice versa, effective vitamin D absorption through sun exposure is not possible without healthy skin. Adequate vitamin D intake through sun exposure is also difficult here. After being activated by sun exposure, the vitamin needs to be converted to vitamin D3 in the liver and kidneys. If organic defects such as liver cirrhosis occur here, conversion into the biologically active vitamin D3 is only possible to a limited extent.
Symptoms, Ailments & Signs
Since Milkman’s syndrome is a pseudo fracture, the typical pain that occurs with broken bones does not exist. However, since the syndrome is part of advanced osteomalacia, dull bone pain occurs all over the body at the same time and is often confused with rheumatic complaints. However, these symptoms are separate from Milkman’s syndrome and typical of osteomalacia in the acute stage.
Diagnosis & disease progression
Milkman syndrome can be detected on radiological images. The Looser remodeling zones of Milkman’s syndrome can be observed particularly in osteomalacia (softening of bones in adults) and rickets (softening of bones in children). In children with rickets, increased sweating, restlessness and skin rash (miliaria) already occur in the first few months of life.
This is followed by muscle weakness and softening of the bones in the skull. Other symptoms such as increased muscle excitability and cramps follow. The back of the head flattens out and the wrists and ankles show increasing widening. Other bone deformities such as bow legs with a focus on the long bones can occur.
By this time, Milkman’s syndrome is already evident on many x-rays and the looser remodeling zones are spreading without proper treatment. The fact that the deficiency affects the growth of the child and can thus cause lifelong damage seems to be particularly serious in the case of rickets. The growth plates cannot undergo such deformation in adult humans, which is the essential difference between osteomalacia and rickets.
Milkman syndrome causes fractures in the bones of patients and thus severe pain. There are also significant limitations in the patient’s movement, which can make everyday life significantly more difficult. Most of those affected also suffer from severe headaches and bone pain that occurs all over the body.
There is increased perspiration and general inner restlessness. It is not uncommon for patients to also suffer from psychological complaints or depression and muscle weakness. The patient’s resilience decreases significantly as a result of Milkman’s syndrome and convulsions often occur. Rest pain can lead to insomnia, especially at night, and thus to irritability in the patient.
As a rule, Milkman syndrome can be treated relatively well and easily, with no particular complications. Life expectancy is also usually not reduced by Milkman syndrome. The treatment itself takes place with the help of medication and quickly leads to success. Furthermore, there are no particular complications.
When should you go to the doctor?
Since Milkman syndrome does not heal itself and the complaints and symptoms usually worsen, a doctor should always be consulted with this disease. The doctor should be consulted if the person concerned suffers from severe pain that can be reminiscent of a fracture or broken bone. The pain can occur in different regions and also significantly reduce the patient’s quality of life. In many cases, those affected suffer from restricted mobility and are therefore restricted in their everyday life.
Rheumatic pains also indicate Milkman syndrome and should be examined by a doctor. The syndrome often leads to inner restlessness or profuse sweating. Many sufferers also have a rash on the skin, which can be associated with itching. Furthermore, a doctor should also be consulted if the patient suffers from muscle weakness without any particular reason. Milkman syndrome can primarily be diagnosed by a general practitioner. However, further treatment is carried out under the supervision of various specialists and often leads to a positive course of the disease.
Treatment & Therapy
For proper treatment, the origin of the deficiency must first be determined. The differentiation between an organic defect and insufficient exposure to the sun appears to be particularly important for therapy. Vitamin D deficiency and the resulting disrupted calcium balance can be treated with conventional dietary supplements such as cod liver oil and vitamin D tablets.
Calcium supplementation is also useful. However, extensive sunbathing is ideal for curing vitamin D deficiency symptoms. Here, in turn, you should pay attention to suitable sun exposure, since too long and intensive exposure can lead to burns, which in turn have a negative effect on the vitamin D supply and can be the cause of other health problems.
However, osteomalacia and rickets can also be triggered by organic disorders. A disturbed conversion process of the vitamin should therefore be clarified in advance.
Outlook & Forecast
The prognosis for Milkman syndrome depends, among other things, on the age of the patient and the cause. A change in diet and frequent exposure to the sun can very quickly stop this deficiency from developing. Certain parts of the bones and joints will already be changed (otherwise Milkman’s syndrome could not be diagnosed at all). But a return to healthy bone structure is possible for the body if properly supported. Vitamin D is particularly important.
In children, the fact that the pseudo-fractures and the associated thickening of the bones interfere with development makes things even more difficult. The entire development of the skeleton can become unstable or deformed by these bone changes. Left untreated, Milkman syndrome in children leads to thickened ankles and wrists and a flat back of the head with simultaneous softening of the bones. However, since the underlying rickets is also an expression of a deficiency symptom, these consequences can be prevented by timely treatment.
Furthermore, Milkman’s syndrome itself almost never leads to true fractures. But rickets or osteomalacia, which usually causes the syndrome, do. Accordingly, those affected can also have lifelong complaints as a result of multiple fractures and poorly or incorrectly healed bones. Restricted movement and pain are common and may persist even after treatment for Milkman syndrome.
Adequate sun exposure is recommended to prevent bone diseases such as osteomalacia. A one-hour stay in the fresh air can be enough for this. If there is not enough sunlight, which is the case in the northern hemisphere, especially in autumn and winter, supplementation with food supplements is necessary.
Milkman syndrome, like any normal fracture, requires follow-up care to ensure the fracture is healing as expected. This requires regular visits to the treating doctor to clarify that no further complications are to be expected. The movement restrictions make everyday life more difficult, so that those affected are sometimes dependent on the help of relatives and friends. The first few weeks after the fracture occurs should be approached calmly and physical exertion should be limited. However, since the immobilisation entails muscle loss, it is advisable to carry out light exercises that have been discussed with the doctor.
You can do that yourself
Milkman syndrome always requires a medical diagnosis. Depending on the underlying cause of the deficiency symptoms, medical treatment is then carried out. Under certain circumstances, this can be supported by various self-help measures.
In order to quickly compensate for the calcium deficit, the diet should be changed first. Calcium is mainly found in kale, broccoli, Brazil nuts, yoghurt and cheese – these foods should be consumed in large quantities, especially in the initial period after the diagnosis. Dietary supplements such as vitamin D tablets are also recommended. If taken regularly, cod liver oil can also help to quickly reduce the symptoms of Milkman syndrome. A lack of vitamin D can be cured by extensive sunbathing. It is also important to treat the individual symptoms.
Bone pain requires medicinal therapy, which can be supported, for example, by valerian, arnica and other gentle natural sedatives and painkillers. A proven remedy from homeopathy is Belladonna, preferably in the potency D12. The doctor should approve the use of these preparations beforehand. Regular visits to the doctor are indicated anyway, because this is the only way to rule out further complications.