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Osteomalacia - Causes, Symptoms, Diagnosis, and Treatment

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Osteomalacia, also known as soft bones, is caused by a deficiency in vitamin D, which is essential for bone health. For more details read below.

Medically reviewed by

Dr. Pradeep Arun Kumar. L

Published At September 2, 2022
Reviewed AtNovember 16, 2023


The minerals calcium and phosphorus are crucial for the development of bones. To properly absorb calcium from meals, the body needs vitamin D. When exposed to sunshine for at least 10 to 15 minutes each day, the skin manufactures vitamin D. Vitamin D insufficiency can cause adults' bones to become weaker and children's bones to develop improperly.

What Is Osteomalacia?

Osteomalacia literally translates to "soft bones." Osteomalacia is a condition that weakens bones and makes them more brittle and susceptible to breaking. It is a condition of reduced mineralization, which causes the bone to break down more quickly than it can regenerate. It is an adult-specific condition. Rickets may develop in children with insufficient vitamin D levels.

What Other Names Are There for Osteomalacia?

Osteomalacia has additional names like:

  1. Vitamin D deficiency - osteomalacia.

  2. Calcium - osteomalacia.

How Does Osteomalacia Develop?

Calcium and phosphates are essential for the body to use in the development of strong bones. Osteomalacia can be brought on by a deficit in calcium, phosphates, or vitamin D, which is required for the body to absorb calcium from meals. The following list of factors could contribute to osteomalacia:

  • Vitamin D Deficiency: The main cause of osteomalacia is a vitamin D deficiency. When exposed to sunshine, the skin produces the majority of the vitamin D that the body needs. Additionally, small amounts can be found in foods including egg yolk, milk, yogurt, cheese, salmon, fish, and breakfast cereal. People who get minimal sun exposure, live in places with limited sunlight, or consume foods poor in vitamin D may develop osteomalacia.

  • Kidney and Liver Diseases: The activation of vitamin D occurs in the kidney and liver. Osteomalacia can result from changes to these mechanisms brought on by renal and liver diseases.

  • Stomach and Intestine Surgeries: The stomach breaks down food to release calcium and other minerals. A lack of calcium or vitamin D might result after surgery that eliminates some or all of the stomach or bypasses the small intestine.

  • Celiac Disease: It is an autoimmune disorder in which eating things containing gluten (a type of protein found in wheat, rye, and barley) can harm the lining of the small intestine. Autoimmune diseases are conditions in which the body's immune system attacks its own body cells. Calcium and other essential elements cannot be absorbed via a damaged lining.

  • Drugs: Osteomalacia can result from a vitamin D deficit brought on by medications for treating seizures, such as Phenytoin and Phenobarbital.

  • Cancer: Processing of vitamin D can be hampered by some cancers.

What Are the Risk Factors for Osteomalacia?

The risk factors for osteomalacia are as follows:

  • Less time spent in the sun.

  • Low vitamin D intake from food.

  • Older individuals.

  • Those who are ill or staying at home.

What Are the Symptoms of Osteomalacia?

  • A significant amount of bone involvement is required for symptoms to manifest in the early stages of the disease. However, osteomalacia can be identified on X-rays taken for other causes.

  • The most frequently observed signs are muscle weakness and bone pain. Lack of calcium and vitamin D contributes to bone pain, and issues in the region where the muscle attaches to the bone are associated with muscular weakening. Typically, the back, pelvis, legs, hips, and ribs are all affected by dull, aching pain. The discomfort is usually greatest at night or when applying pressure to the bone. Rest helps to ease it to some extent.

  • A disorder known as a waddling gait (a style of walking in which people wobble from side to side and the hip descends with each step) is caused by muscle weakness and lack of muscle tone and can make walking challenging and slower.

  • Low blood calcium levels can cause a variety of symptoms, such as

    • Numbness around the mouth.

    • The tingling in one's feet and hands.

    • Heart rhythm irregularity.

    • Hands and feet spasms or muscle contractions.

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 with proper treatment planning based on healthcare needs.

How Is Osteomalacia Diagnosed?

To diagnose osteomalacia, doctors may suggest the following tests:

Blood Test: The following blood test results are indicative of an osteomalacia diagnosis:

  • Low levels of calcium.

  • Low levels of phosphorus.

  • Low amounts of vitamin D.

  • High alkaline phosphatase.

  • Elevated parathyroid hormone levels.

X-rays: Small cracks in the bones can be seen on X-rays and other imaging procedures. These cracks are known as Looser's transformation zones. Even minor injuries in these areas might lead to fractures.

Biopsy: To remove a small amount of bone tissue, the surgeon inserts a fine needle into the bone via the skin. This sample is given to the laboratory for additional examination to confirm osteomalacia. Blood testing and imaging tests are typically adequate to confirm the diagnosis, and a biopsy is only sometimes required.

How Is Osteomalacia Treated?

  • Calcium, phosphorus, and vitamin D oral supplements can be used to treat osteomalacia. By taking the recommended medications as directed for a few months to years, the illness can be treated. However, affected individuals must be routinely observed to measure blood calcium, phosphate, and vitamin D levels.

  • To improve the quantity of calcium and vitamin D ingested through diet, doctors or dietitians may also suggest dietary adjustments.

  • Treatment of diseases including liver and kidney illnesses, which interfere with vitamin D metabolism, is required to address osteomalacia's warning signs and symptoms.

  • Children who have severe osteomalacia or rickets may require surgery to fix bone deformities and orthodontic treatment for aligning their teeth.

How Can Osteomalacia Be Prevented?

By obtaining enough sun exposure and eating a diet high in calcium and vitamin D, osteomalacia can be avoided. Vitamin D can be found naturally in egg yolks and oily fish (such as salmon, mackerel, and sardines). Wheat products like bread, cereals, milk, and yogurt are enriched with vitamin D.


Osteomalacia is a disorder that weakens and softens bones, increasing the risk of fracture. Even though it cannot be detected at an early stage, signs like bone pain and muscular weakness necessitate quick medical attention to avoid complications like fractures. Taking calcium and vitamin D pills and getting enough sun exposure are part of the treatment. The average patient has to take supplements after their illness has improved to maintain a normal life because bone repair takes about six months.

Dr. Pradeep Arun Kumar. L
Dr. Pradeep Arun Kumar. L

Orthopedician and Traumatology


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