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Osteomalacia - Causes, Symptoms, Diagnosis, and Treatment

Published on Sep 02, 2022   -  5 min read


Osteomalacia is a condition caused due to severe vitamin D deficiency. Keep reading to know more about osteomalacia.


Calcium and phosphorus are important minerals that help in bone formation. The human body requires vitamin D for the absorption of calcium from the foods consumed. The skin prepares vitamin D when exposed to sunlight for at least 10 to 15 minutes per day. The deficiency of vitamin D can lead to improper formation of bones in children and weakening of bones in adults.

What Is Osteomalacia?

Osteomalacia or “soft bones” refers to a disease that causes the weakening of bones due to a deficiency of vitamin D. There is a decrease in mineralization, leading to bone softening and fractures. In children and young adults, there is bowing of the bones, especially in the weight-bearing areas of the legs, whereas in adults, it can lead to fractures. Insufficient concentrations of vitamin D causing soft bones in children are called rickets.

What Are the Other Names of Osteomalacia?

The other names of osteomalacia include:

  1. Vitamin D deficiency - osteomalacia.

  2. Calcium - osteomalacia.

What Are the Causes of Osteomalacia?

The body needs calcium and phosphates to help in the formation of strong bones. Either a deficiency of calcium or phosphates or a lack of vitamin D necessary for the absorption of calcium from foods can cause osteomalacia. The causes of osteomalacia can include the following:

  • Vitamin D Deficiency: The deficiency of vitamin D is the most common cause of osteomalacia. The major part of vitamin D is formed in the skin upon exposure to sunlight. Small amounts are also obtained from dietary sources such as egg yolk, milk, yogurt, cheese, salmon, fish, and breakfast cereal. People who get limited exposure to sunlight, live in countries with limited sunlight, are darkly pigmented people, or who consume foods having low vitamin D can develop osteomalacia.

  • Surgeries of Stomach and Intestines: The stomach functions by breaking down food to release calcium and other nutrients. A surgery that removes a part or all of the stomach or bypasses the small intestine can lead to calcium or vitamin D deficiency.

  • Celiac Disease: It is an autoimmune disease (a disease in which the body’s immune system destroys its own body cells) in which foods containing gluten (a type of protein in wheat, rye, and barley) can cause damage to the lining of the small intestine. A damaged lining cannot cause the absorption of calcium and other necessary nutrients.

  • Drugs: Medicines used to treat seizures like Phenytoin and Phenobarbital can cause deficiency of vitamin D leading to osteomalacia.

What Are the Risk Factors for Osteomalacia?

The following are the risk factors for osteomalacia, that include:

  • Less exposure to sunlight.

  • Low dietary intake of vitamin D.

  • Elderly people.

  • People who are hospitalized or housebound.

What Are the Symptoms of Osteomalacia?

  1. Symptoms do not show in the early stages of the disease but are present only after there is considerable involvement of the bone. However, osteomalacia may be detected on X-rays taken for other reasons.

  2. The most commonly noticed symptoms include bone pain and muscle weakness. Bone pain occurs due to a deficiency of calcium and vitamin D, and muscle weakness is related to problems in the area of attachment of the muscle to the bone. The dull, aching pain usually affects the back, pelvis, legs, hips, and ribs. The pain tends to be worse at night or when pressure is applied to the bone. It is partially relieved by rest.

  3. Muscle weakness and loss of muscle tone can make walking difficult and slower, called a waddling gait (a type of walking in which you sway from side to side and the hip drops with each step).

Symptoms that occur due to low blood calcium levels include:

  • Numbness around the mouth.

  • The tingling sensation of the hands and feet.

  • Irregular rhythmic activity of the heart.

  • Spasm or muscle contractions of the hands and feet.

What Are the Complications of Osteomalacia?

Neglect in the treatment of causes can lead to complications of osteomalacia. Adults are more prone to bone fractures. In children, there can be bowing of bones under pressure and also premature tooth loss. Symptoms can reappear if sufficient amounts of vitamin D supplements are not taken as advised or if the underlying cause is not addressed. A doctor can help in proper treatment planning based on healthcare needs.

How Is Osteomalacia Diagnosed?

Doctors may advise the following tests to diagnose osteomalacia, which include:

Blood Tests: Diagnosis of osteomalacia is confirmed if the blood test reports show:

  • Low calcium levels.

  • Low phosphorus levels.

  • Low vitamin D levels.

  • High levels of alkaline phosphatase.

  • High levels of parathyroid hormone.

X-rays: X-rays help detect small cracks in the bones called Looser’s transformation zones. The smallest injuries to these areas can trigger fractures.

Biopsy: The surgeon passes a thin needle through the skin into the bone to remove a small amount of bone tissue. This sample is sent to the laboratory for further analysis to confirm osteomalacia.

In most cases, blood tests and imaging tests are sufficient to confirm the diagnosis, and a biopsy is rarely needed.

How Is Osteomalacia Treated?

  • Osteomalacia can be treated by taking oral supplements containing calcium, phosphorus, and vitamin D. The condition is cured by taking the prescribed medications for a period of a few months to years. However, affected people need to be monitored periodically to check the levels of blood calcium, phosphates, and vitamin D.

  • Doctors or dietitians may also advise changes in the diet to increase the amounts of calcium and vitamin D intake through diet.

  • Conditions like liver and kidney disorders that affect the metabolism of vitamin D need to be treated to correct the signs and symptoms of osteomalacia.

  • Children with severe osteomalacia or rickets might need treatments that include surgeries to repair bone deformities and braces treatment for correction of misaligned teeth.

What Are the Ways to Prevent Osteomalacia?

Osteomalacia can be prevented by getting adequate sun exposure and consuming a diet rich in calcium and vitamin D. Oily fish (salmon, mackerel, and sardines) and egg yolks are natural sources of vitamin D. Foods fortified with vitamin D include bread, cereals, milk, and yogurt.


Osteomalacia is a condition that causes softening and weakening of bones which makes them more prone to fractures. Though it cannot be diagnosed early, symptoms like bone pain and muscle weakness require immediate consultation with the doctor to prevent complications like fractures. Treatment includes calcium and vitamin D supplements along with adequate exposure to sunlight. Bone healing takes around six months, and most patients need to take supplements after the improvement of the condition to maintain a normal life.


Last reviewed at:
02 Sep 2022  -  5 min read




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