Osteomalacia: Definition, Types, Causes, Symptoms, Diagnosis and Treatment

It constitutes defective mineralization of all the bones that make up the skeleton.

This occurs when there are inadequate amounts of minerals in the bones, especially calcium and phosphorus, causing them to soften significantly.

Osteomalacia mainly affects adults and is usually due to a severe vitamin D deficiency.

This substance is involved in allowing minerals to settle in the bones or inadequate exposure to the sun, which is required as part of the vitamin D synthesis process.

Other causes may have problems with the absorption of calcium or phosphorus or a severe loss of these minerals.

Osteomalacia is a disease in which the bones become soft and weak.

This can lead to fractures in adults and children and abnormal growth and development in children.


Osteomalacia is a decalcification of the bones that is called rickets when it occurs in children.

Types of Osteomalacia

There are several types of Osteomalacia:

  • Axial Osteomalacia, which affects the spine.
  • Vitamin-resistant Osteomalacia is a genetic defect that blocks the synthesis of vitamin D.
  • Hypophosphatemic osteomalacia, due to kidney dysfunction


Calcium, phosphorus, and vitamin D are necessary nutrients for developing and maintaining strong and healthy bones.

Osteomalacia occurs due to the body’s inability to absorb calcium and phosphorus from food and carry these minerals into the bones for strength.

Vitamin D is necessary for this process, and Osteomalacia can result from various vitamin D problems.

These include a lack of vitamin D in the diet and insufficient exposure to sunlight.

Exposure to sunlight produces vitamin D in the body, and the sunlight is the primary source of vitamin D.

There may also be a problem with poor vitamin D absorption from the intestines.

Osteomalacia is rare when people generally get enough exposure to sunlight for their bodies to make vitamin D.

In the northernmost areas of the world, such as Alaska or the Scandinavian countries, where the hours of sunlight can be concise, there is an increased risk of developing Osteomalacia.

Other populations at risk of contracting the disease are the elderly and people living in long-term care.

Dairy products that contain calcium and are fortified with vitamin D, such as milk, should be consumed.

People who are lactose intolerant or do not eat enough dairy products are at high risk of developing Osteomalacia.

It would help if you always used a powerful sunscreen, and having dark skin also increases your risk.

Dark skin and sunscreen block the absorption of the sun’s rays, which the body needs to make vitamin D.

Some chronic diseases that interfere with the absorption or metabolism of vitamin D can cause Osteomalacia.

These include alcoholism, cancer, liver disease, celiac disease, and vitamin D metabolism disorders.

Other causes include the autoimmune disorder known as celiac disease.

When you have celiac disease, the lining of a person’s small intestine is damaged by gluten-rich foods, and it does not absorb nutrients.

Another cause is chronic pancreatitis, when the pancreas becomes inflamed and does not break down food and nutrients.

Other disorders interfere with vitamin D metabolisms, such as kidney failure or primary biliary cirrhosis.

Also, the intake of anticonvulsant medications such as phenytoin or phenobarbital and inherited genetic disorders in which a person has low enzymes necessary to build bones.

In some cases, gastrectomy, a surgical procedure that involves removing part or all of a person’s stomach, removes a person’s ability to metabolize vitamin D through the gastronomic tract, which must be absorbed through the intestines.

The absence of the small intestine or a large part of the stomach can lead to Osteomalacia.

Symptoms of Osteomalacia

The first symptoms manifest as bone pain, particularly pain in the lower back and thighs.

This bone pain usually spreads to the arms and ribs.

Most patients describe the pain as symmetrical and non-radiating, often in conjunction with a sensation of bony tenderness.

The muscles surrounding the affected bones also show weakness, and everyday activities such as climbing stairs or standing up from a squat position become more complex.

In general, the patient will feel weak and in some pain.

As the disease progresses, most physical activities become uncomfortable and are often accompanied by pain.

Patients will notice that gentle pressure on the affected bones can also cause severe pain.

Muscle weakness and stiffness in the limbs worsen, and any movement will cause discomfort.

Most people affected by Osteomalacia can be distinguished by their slow gait.

Symptoms of Osteomalacia include bone deformities, growth problems, and bone fractures in severe cases.

Other severe symptoms include complications such as bone fractures, which can occur spontaneously or after minimal injury.

Other more subtle symptoms can appear in less severe cases.

The symptoms of Osteomalacia vary depending on the stage of the disease and the individual.

Symptoms in adults and children with the disease can include muscle weakness, bone pain, muscle cramps, muscle stiffness, numbness or tingling, weakness, and fatigue.

There may also be abnormal heart rhythms called cardiac arrhythmias. This can be a severe and life-threatening symptom.

Osteomalacia in children, or rickets, can cause severe growth and development problems.

These include delayed or malformed teeth, bowed legs, pigeon chest, and other skeletal deformities of the skull, rib cage, pelvis, and spine.

These children grow into adults who are very short in stature, usually less than 1.5 meters tall.

The list of signs and symptoms for Osteomalacia include those listed below:

  • Fragile bones.
  • Bone-ache.
  • Pain in the spinal cord
  • Pelvic bone pain
  • Leg bone pain.
  • Severe muscle fatigue, resulting in gait.
  • Pain in the back and chest.
  • Compaction of the spine in the most severe cases.
  • Muscular weakness.
  • Hypocalcemia
  • Pelvic flattening.
  • Fractures
  • Bone decalcification.
  • Bending of bones.

Osteomalacia occurs most often in adults who have dark skin or an unbalanced diet.

In most cases, many of the symptoms are similar to those of degenerative bone disease osteoporosis.

Except that the former is caused by a defect in the mineralization of bone osteoid, its main protein framework, which results from a vitamin D deficiency.


The diagnosis of Osteomalacia begins with a complete personal and family medical history, including symptoms and a physical exam.

To make an accurate diagnosis, the doctor will write down a person’s medical history and list the symptoms experienced by the patient.

Diet considerations and the amount of sunlight exposure will also be determined.

Diagnostic tests include blood tests that measure vitamin D, calcium, and phosphate levels.

X-rays are used to find any visible cracks in a patient’s bones, known as Looser transformation zones.

Bone density tests can detect fractures and bone loss; bone scans determine bone metabolism.

However, the most definitive test is a bone biopsy, which examines a sample of bone tissue under a microscope to confirm Osteomalacia’s presence accurately.

Your doctor may order blood and urine tests to check vitamin D, phosphorus, and calcium levels.

Because the symptoms and presentation of Osteomalacia are similar to some other conditions, a delayed diagnosis of the disease is possible.

To rule out any underlying disorders that may be causing the symptoms, the doctor may also recommend a parathyroid hormone test, calcium ionization tests, isozyme tests, and the alkaline phosphatase test.

Treatment of Osteomalacia

Osteomalacia is a very preventable disease. It is also treatable and curable if diagnosed quickly.

Deformed bones do not regain their shape in patients diagnosed with Osteomalacia.

In more advanced cases, pathological fractures become more common as the bones become more and more brittle.

Chronic fatigue becomes a constant companion for sufferers, and low calcium levels cause numbness in the mouth and extremities, hand and foot spasms, and arrhythmia.

People whose diet is low in foods rich in vitamin D, such as milk and cereals, or those who do not take the average daily vitamin D requirement in the form of supplements are also prone to Osteomalacia.

Therefore, it is essential as the initial treatment for Osteomalacia is the prescription of supplements and a diet rich in vitamin D.

Suppose Osteomalacia is due to a vitamin D deficiency. In that case, treatment may consist of increased exposure to sunlight, a diet rich in foods containing vitamin D, daily vitamin D supplements, and calcium.

In some cases, an injection of vitamin D can be given intravenously.

Treatment of Osteomalacia will depend on the factors causing the disease.

Patients with significant intestinal malabsorption of this vitamin will need higher calcium and vitamin D doses.

In patients whose Osteomalacia is severe, there are cases in which orthopedic surgery may be necessary.

Children with hypophosphatemic rickets with X lines are given supplements rich in calcitriol and phosphate and are subject to regular medical monitoring of their condition.

When Osteomalacia is diagnosed as secondary to other conditions, such as primary biliary cirrhosis or kidney failure, treating the underlying disorder will alleviate the symptoms of Osteomalacia.

All patients undergoing treatment for Osteomalacia will also undergo regular inspection to monitor their phosphorus and calcium levels and take vitamin D regularly to prevent the recurrence of the disease.