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Osteomalacia

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What is osteomalacia?

In order to make healthy bone, your body needs calcium and vitamin D. Osteomalacia is a condition in which your bones become soft because of a lack of calcium and phosphate, often due to not getting enough vitamin D.

In children, whose bones are still growing, this condition is called rickets.

Bones in osteomalacia. 

Causes

Your body needs vitamin D in order to absorb calcium and phosphorus, which are both necessary for making strong, healthy bone. When vitamin D, calcium or phosphorus levels are poor, bones can become soft and prone to fractures.

Vitamin D is found in some foods, particularly fish and dairy products (see below for details). However, in most people, vitamin D is produced by the body. Skin cells make a precursor of vitamin D when exposed to sunlight.

The precursors of vitamin D obtained from food and skin cells then get processed in the liver and kidneys to produce the active form of vitamin D.

Vitamin D synthesis in the body. 

Most people have enough vitamin D by some combination of these two routes. However, people who eat a diet poor in vitamin D and who also are not exposed to enough sunlight may be deficient in vitamin D. Problems in processing vitamin D in the gastrointestinal tract, liver or kidneys can also cause vitamin D deficiency.

Risk factors

Risk factors for osteomalacia include:

  • A diet poor in vitamin D or calcium;
  • Living in areas or conditions where you get very little exposure to sunlight, or regularly wearing clothing that covers nearly all of your body;
  • Having darker skin;
  • Being of an older age;
  • Having a condition that interferes with vitamin D metabolism, including some bowel diseases, kidney or liver problems;
  • Having a condition that interferes with calcium metabolism;
  • Taking certain medications, such as medication for treating osteoporosis [1] , and;
  • Being a breastfed infant whose mother is vitamin D deficient.

Signs and symptoms

Signs and symptoms of osteomalacia include:

Methods for diagnosis

Your doctor will diagnose osteomalacia based on your symptoms and the results of tests, including:

Types of treatment

Treatment of osteomalacia focuses on you getting enough vitamin D, calcium and phosphorus in your diet and getting regular sunlight exposure. Your doctor may advise you to add certain vitamin-rich or calcium-rich foods to your diet, or to begin taking nutritional supplements.

Dietary vitamin D

Good sources of dietary vitamin D include:

Exposure to sunlight

Your body needs some exposure to sunlight in order to make vitamin D. The ultraviolet radiation in sunlight (specifically UVB) activates the vitamin.

However, UVB exposure puts you at risk of skin cancer. Striking the right balance between underexposure and overexposure is not always easy. Note that your body needs only a few minutes daily of direct sunlight - in the morning or afternoon - in order to make active vitamin D.

Prognosis

If vitamin D levels return to normal, osteomalacia should go away within a few weeks to months.

Prevention

Unless there is an underlying medical condition, osteomalacia can be prevented by including enough vitamin D in your diet and getting enough sunlight.

References

  1. Holick, M.F. (2007). Vitamin D Deficiency. New England Journal of Medicine 357: 266–281.
  2. Board A.D.A.M.E. (2014). Osteomalacia. PubMed Health. Accessed from link here
  3. Choices N.H.S. (2014 January 15). Rickets - NHS Choices. Accessed 20 October 2014 from link here
  4. Holick M.F. (2007). Vitamin D Deficiency. New England Journal of Medicine 357: 266–281.
  5. Holick M.F. (2013). Bioavailability of Vitamin D and Its Metabolites in Black and White Adults. New England Journal of Medicine 369: 2047–2048.
  6. Osteomalacia. Accessed 20 October 2014 from link here
  7. Osteomalacia articles: NEJM.org. New England Journal of Medicine. Accessed 20 October 2014 from link here
  8. Osteomalacia Medication | Drugs.com. Accessed 20 October 2014 from link here
  9. Osteomalacia - Springer. Accessed 20 October 2014 from link here
  10. Reddy Munagala V.V. & Tomar V. (2014). Osteomalacia. New England Journal of Medicine 370: e10.
  11. Rickets. Better Health Channel. Accessed 20 October 2014 from link here
  12. Rickets : The Lancet. Accessed 20 October 2014 from link here
  13. Rosen C.J. (2011). Vitamin D Insufficiency. New England Journal of Medicine 364: 248–254.
  14. Vitamin D — Health Professional Fact Sheet. Accessed 20 October 2014 from link here
  15. Vitamin D supplementation: bones of contention : The Lancet. Accessed 20 October 2014 from link here
  16. Vollbrecht J.E. & Rao D.S. (2008). Tumor-Induced Osteomalacia. New England Journal of Medicine 358: 1282–1282.
  17. Walker J. (2014). Pathogenesis diagnosis and management of osteomalacia. Nursing Older People 26: 32–37.

9 Most frequently asked questions (FAQs)

What is osteomalacia?
Osteomalacia is a condition in which your bones become soft due to a lack of calcium and phosphate, often because you are not getting enough vitamin D.
What are the symptoms of osteomalacia?
Signs and symptoms of osteomalacia include: increased risk of fractures; fractures that happen without injury; widespread bone pain and tenderness, especially in the pelvis and lower back; difficulty walking; walking with a waddle, and; muscle weakness.
What causes osteomalacia?
The most common cause of osteomalacia is vitamin D deficiency.
Who gets osteomalacia?
People who do not receive enough sunlight and/or vitamin D in their diet are especially at risk of osteomalacia.
How is osteomalacia diagnosed?
Your doctor will diagnose osteomalacia based on your symptoms, blood tests, and by examining your bones by X-ray or other methods.
How is osteomalacia treated?
Treatment of osteomalacia focuses on you getting enough vitamin D, calcium and phosphorus in your diet and getting regular sunlight exposure. Your doctor may advise you to add certain vitamin-rich or calcium-rich foods to your diet, or to begin taking nutritional supplements.
Can osteomalacia be cured?
Osteomalacia will go away after the body receives enough vitamin D.
Can osteomalacia be prevented?
Unless there is an underlying medical condition, osteomalacia can be prevented by including enough vitamin D in your diet and getting enough sunlight.
Is osteomalacia serious?
Osteomalacia can lead to fractures that may have serious effects on your ability to move and function.

Related topics

Hyperparathyroidism

Hyperparathyroidism occurs when the parathyroid glands are overactive and produce too much parathyroid hormone (PTH). In turn, this overproduction of PTH causes high levels of calcium to be absorbed into the blood from the bones and food.

Osteoporosis

Osteoporosis occurs when bones become brittle and are more easily fractured. It is more common in women, particularly after menopause when oestrogen levels are low, as oestrogen helps maintain bone mass. Numerous treatment options are available for osteoporosis.

Ankylosing spondylitis

Ankylosing spondylitis is a form of arthritis in which the joints of the spine become inflamed, in particular where the spine attaches to the pelvis. It usually develops in young adults and causes pain and stiffness, especially in the lower back. Eventually, fusion of vertebrae in the spine can occur.

Avascular necrosis (osteonecrosis)

Avascular necrosis describes the death of bone tissue that occurs when the blood supply to an area of bone is cut off. It causes severe damage to the bone and is also known as ischemic bone necrosis, aseptic necrosis, bone infarction and osteonecrosis.

About this article

Title: Osteomalacia

Author: Dr Idan Ben-Barak PhD, MSc, BSc (Med)

First Published: 13 Jul 2015

Last reviewed: 17 Jan 2022

Category: Information on Osteomalacia

Average rating: 4.5 out of 5 (1557 votes)

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