Osteomalacia: Causes, Symptoms, Diagnosis & Treatment

Osteomalacia: Causes, Symptoms, Diagnosis & Treatment

Osteomalacia is a disease that affects bones by softening and diminishing them. Although people of all ages can develop this disease, adults over 50 are more likely to do so.  


Osteomalacia is a disease that affects bones by softening and diminishing them. Although people of all ages can develop this disease, adults over 50 are more likely to do so.

To grow and maintain strong bones, the body requires adequate amounts of calcium and phosphate, both of which are controlled by vitamin D. Lack of vitamin D reduces the amount of calcium and phosphate that is absorbed from the intestines, which lowers the amounts of these minerals in the blood. In turn, this causes the development of fragile, frail bones that are prone to breaking.

Overall, osteomalacia is a treatable condition, and with the right care, those who have it can significantly enhance both their quality of life and the health of their bones.

What is osteomalacia?

A medical disorder called osteomalacia weakens and softens the bones.

It is added on through a lack of calcium, phosphorus, or nutrition D in the body. These factors are indispensable for the formation and maintenance of robust bones. Without them, bones may additionally grow to be fragile, susceptible to breakage, and feeble.

All ages can be affected by osteomalacia, but people over 50 are more likely to develop it. It is frequently brought on by a failure to absorb vitamin D from food or by a lack of exposure to sunlight, which is a source of vitamin D.

Explore the Epidemiology of osteomalacia:

  • The epidemiology of the rare disease osteomalacia varies based on the local population and environment. In industrialised nations, older people with poor diets, little sun exposure, or malabsorption problems are more likely to experience it.
  • Osteomalacia is thought to impact fewer than 1 in 100,000 Americans each year.
  • However, some groups are more susceptible to the disease than others, such as those with gastrointestinal conditions that impair nutrient absorption.
  • Due to poor nutrition and limited sun exposure, osteomalacia affects children and young people more frequently in developing nations. As much as 25–30% of the people in these regions may have osteomalacia.
  • Since osteoporosis is more common in women than in men and raises the risk of fractures and vitamin D deficiency, probably, women are more frequently affected by osteomalacia than men.
  • Osteomalacia risk can also be increased by certain medical conditions, such as chronic kidney disease and liver illness.

Embracing the pathophysiology of osteomalacia:

As a consequence of osteomalacia, which affects bone metabolism, bones become softer and weaker. Numerous mechanisms are involved in the complicated pathogenesis of osteomalacia, which can impair normal bone mineralization and formation processes.

  • A lack of vitamin D, which is necessary for the uptake of calcium and phosphate from the intestines, is the main contributor to osteomalacia.
  • Low amounts of calcium and phosphate in the bloodstream brought on by vitamin D deficiency can prevent bones from properly mineralizing.
  • Osteoblasts, which are bone cells, are unable to correctly deposit new bone matrix in the absence of enough minerals, which results in the development of soft and frail bones. Fracture risk is also increased by the demineralized bone structure.
  • In addition, secondary osteomalacia can result from chronic kidney illness. Vitamin D is converted to its active version by the kidneys, and when the kidneys are damaged, less active vitamin D is produced.
  • Demineralized bones may result from reduced calcium absorption and increased phosphate excretion as a result of this.
  • Along with disrupting regular bone metabolism, some medications can also cause osteomalacia. Anticonvulsants, which can lower vitamin D levels, and antacids containing aluminum, which can bind to phosphate and block its absorption, are some of these drugs.

Various causes of osteomalacia:

Osteomalacia is brought on by a lack of calcium, phosphorus, or vitamin D in the body, which can be brought on by a variety of causes.

The following are the root reasons for osteomalacia:

  • Lack of vitamin D:

Vitamin D is essential for the physique to take in calcium and phosphorus. Lack of nutrition D can result in decreased blood tiers of calcium and phosphate, which can cause smooth and vulnerable bones.

  • This can be prompted by utilizing inadequate nutrition D consumption, inadequate solar exposure, or malabsorption problems. Vitamin D, calcium, and phosphate can be malabsorbed as a result of positive digestive system-affecting scientific problems like celiac disease, Crohn's disease, and different inflammatory bowel diseases.
  • Chronic kidney disease can make it more difficult for vitamin D to be converted to its active state, which in turn reduces calcium and phosphate absorption and causes demineralized bones.


  • Medication:

Certain medicines, such as anticonvulsants and antacids that contain aluminium, can interfere with the metabolism and absorption of vital minerals, which can result in osteomalacia.

Osteomalacia and vitamin D deficiency are both caused by liver disease, which can prevent the liver from converting vitamin D into its active state.

  • Rare genetic conditions:

By impeding the metabolism of phosphate and calcium, rare genetic conditions like X-linked hypophosphatemia and autosomal dominant hypophosphatemic rickets can lead to osteomalacia.

Overall, many different variables can contribute to a lack of vital minerals needed for strong bone growth and maintenance, which can result in osteomalacia.

Signs and symptoms exhibited by the patients:

Numerous of the signs and symptoms of osteomalacia are identical to those of other bone disorders.

Depending on the degree of bone demineralization, the symptoms can range in intensity and might include:

  • Osteomalacia may result in severe bone pain, especially in the legs, lower back, hips, and pelvis.
  • Pain that is severe enough to prevent sound slumber may get worse at night. Lack of calcium and phosphorus can cause the muscles to become weakened, resulting in tiredness and weakness.
  • Patients might have trouble carrying heavy objects, standing up from a sitting posture, or climbing steps.
  • Even with minor injuries, soft bones are more vulnerable to fractures. In patients with osteomalacia, fractures of the vertebrae, hips, pelvis, or other bones may occur.


  • Deformities:

Severe bone thinning can result in skeletal deformities like bow-legged ankles or a curved spine. Nerve damage brought on by a calcium deficiency can result in tingling, numbness, or a "pins and needles" feeling in the hands, feet, and cheeks.

  • Oral issues:

Tooth decay, gum disease, and other oral issues can be brought on by a vitamin D deficiency.

  • Fatigue and Sadness:

Patients with osteomalacia may experience fatigue and depression due to chronic pain, muscle weakness, and other symptoms.

  • Skeletal deformities, such as bow-legged feet or a curved spine, can be caused by severe bone thinning.
  • The hands, feet, and cheeks may experience tingling, numbness, or a "pins and needles" sensation due to nerve damage brought on by a calcium shortage.


  • Oral problems:

A vitamin D shortage can lead to oral problems like tooth decay, gum disease, and other oral problems. Due to their chronic pain, muscular weakness, and other symptoms, patients with osteomalacia may experience fatigue and depression.

Various Diagnostic methods:

The test for measuring the quantity of calcium and phosphate excreted in the urine over 24 hours is the 24-hour urine calcium and phosphate test. Low amounts could be a sign of osteomalacia. Alkaline phosphatase (ALP) and parathyroid hormone (PTH) assay PTH and ALP levels in the blood are measured by these procedures. PTH and ALP values that are high could be a sign of osteomalacia.

Osteomalacia is a disease that causes the bones to soften as a result of calcium or vitamin D deficiency.

Here are a few typical ways to diagnose osteomalacia:

  • Blood tests:

Blood tests can determine the blood's amounts of calcium, phosphorus, and vitamin D. These minerals' low concentrations may be a sign of osteomalacia.

  • X-rays:

X-rays can reveal the lack of bone mineralization, which is a defining aspect of osteomalacia. X-rays, however, might not detect osteomalacia in its early stages.

  • Dual-energy X-ray absorptiometry (DXA) scans, also known as bone density scans, can assess the bone mineral density and reveal whether or not bones are weaker than usual.


  • Biopsy:

To perform a bone biopsy, a tiny piece of the affected bone is removed and examined under a microscope.

  • Other imaging tests:

To detect bone abnormalities or fractures linked to osteomalacia, imaging tests like computed tomography (CT) scans or magnetic resonance imaging (MRI) may be used.

It's significant to remember that these diagnosis techniques may be combined to determine osteomalacia with accuracy. A medical expert's advice is necessary for a correct diagnosis and course of treatment.

Treatment Strategies:

Osteomalacia is treated by addressing the underlying source of the condition and restoring the body's mineral deficiencies.

The most widely used treatments for osteomalacia are as follows:

  • Supplemental vitamin D:

Vitamin D administration, which can help the body return to normal calcium and phosphorus levels, is the most successful treatment for osteomalacia. Depending on how severe the deficiency is, the dosage and length of the therapy may change.

  • Calcium supplements:

Patients with osteomalacia frequently have low calcium levels in their bodies, so doctors may recommend calcium pills to help restore those levels. Depending on how severe the deficiency is, the dosage and length of the therapy may change.

  • Phosphate supplements:

Patients with osteomalacia frequently have depleted reserves of phosphate in their bodies, so phosphate supplements may be recommended to help replenish those stores.

Depending on how severe the deficiency is, the dosage and length of the therapy may change.

  • Sun exposure:

The body can naturally create vitamin D with the help of sunlight, which can help treat osteomalacia. To prevent skin damage, however, sun exposure should be limited.

  • Changing one's diet to include foods high in vitamin D, calcium, and phosphates, such as fatty fish, dairy products, and leafy greens, may be recommended for patients with osteomalacia.


  • Treatment of underlying conditions:

If an underlying medical condition, such as kidney or liver illness, contributed to the development of osteomalacia, that condition must be treated first.

Preventive measures:

Maintaining healthy amounts of calcium, phosphorus, and vitamin D in the body is essential for preventing osteomalacia.

Some actions that can be done to stop the onset of osteomalacia include the ones listed below:

  • Sun exposure:

Sunlight contact is a key source of vitamin D. Going outside, particularly when the sun is shining brightest, can aid the body's natural production of vitamin D.

  • Supplements with vitamin D may be required in some circumstances to keep the body's amounts of this vitamin at a healthy level. For people who are at risk of a deficiency, such as those with little solar exposure, the elderly, and those with malabsorption diseases, vitamin D supplements are crucial.
  • Diets high in calcium and phosphate, such as those containing dairy products, leafy greens, and nuts, can support the body's ability to keep healthy amounts of these minerals.


  • Regular exercise:

Regular exercise can protect against bone demineralization and help keep bones healthy.

  • Monitoring and managing underlying medical conditions:

To stop the development of osteomalacia, underlying medical conditions that can lead to the condition, like kidney or liver disease, should be quickly identified and treated.

Overall, osteomalacia can be avoided by leading a healthy lifestyle that includes frequent exercise, sun exposure, and a calcium, phosphorus, and vitamin D-rich diet. People who are susceptible to vitamin and mineral deficiencies should have frequent checks, and they may need to take supplements.

Complications of osteomalacia, if not treated:

Osteomalacia can cause several complications that can lower a person's quality of life if it is untreated or badly managed.

Potential consequences of osteomalacia include the following:

  • Osteomalacia can weaken bones and increase their susceptibility to breaks. Osteomalacia patients are especially prone to hip fractures.


  • Muscle weakness:

A nutrition D deficiency can reason muscle weakness, which can make it challenging for a character to elevate out daily tasks.

  • Skeletal deformities:

Osteomalacia, specifically in younger infants, can end in skeletal deformities. This may additionally motivate spinal abnormalities, knock-knees, and legs that bow.

  • Dental issues:

A nutrition D scarcity can end in dental troubles like tooth decay, gum disease, and enamel defects. Hypocalcemia is an ailment marked by low tiers of calcium in the blood, and osteomalacia can cause it. Seizures, muscular spasms, and cramps can result from this.

  • Increased hazard of infections:

Vitamin D is vital for retaining a wholesome immune system, and its lack can make infections extra likely. Overall, osteomalacia problems can be serious and damage a person's great quality of life.

  • These problems can be prevented and the affected person's effects can be more advantageous via early prognosis and immediate therapy. In conclusion, osteomalacia is an ailment that motivates the bones to soften and weaken due to a lack of nutrition D, calcium, or phosphate.
  • Numerous things, such as inadequate solar exposure, dietary deficiencies, and underlying scientific conditions, can make contributions to the illness.

Finally, maintaining ample ranges of diet D, calcium, and phosphate via daylight exposure, dietary changes, and diet and mineral dietary supplements is essential for the prevention of osteomalacia.