Bone health is important for a healthy body. Osteoporosis and osteomalacia are two diseases that affect the bones. While they both weaken the bones, they act in different ways.

Knowing the difference between the two can help you talk with a medical professional about your symptoms and get the appropriate diagnosis and treatment.

Osteomalacia and osteoporosis are two different conditions that affect the bones.


Osteomalacia is a condition that softens bones. In children, it’s called rickets. It involves problems with bone formation and the bone-building process, resulting in weakening of the bones.

It is most often caused by a vitamin D deficiency, which helps you absorb calcium.

A lack of vitamin D can be caused by:

  • issues in your diet
  • lack of sun exposure
  • intestinal issues

Sometimes the body has trouble absorbing vitamin D, leading to a deficiency. Various health conditions can cause problems with nutrient absorption, including:

  • celiac disease
  • certain kinds of cancer
  • kidney and liver disorders
  • medications for certain conditions like seizures


Osteoporosis is when your bone mineral density and bone mass decreases, or when the quality or structure of the bone changes. Over time, this can cause a reduction in bone strength, increasing the risk of fractures.

The inside of a bone typically has spaces akin to a honeycomb structure. In osteoporosis, these spaces are bigger than in healthy bones, which weakens the bone.

The biggest risk factor for osteoporosis is age. Your body breaks down bone faster than it replaces it, making bones weaker and more prone to fracture. Menopause can also be a risk factor because changes in hormone levels lead to quicker bone loss.

Other risk factors can include:

  • family history of osteoporosis
  • poor nutrition
  • smoking
  • low body weight
  • small body frame

According to research provided by the National Osteoporosis Foundation, osteoporosis is more prevalent in women, with the highest occurrence in white and Asian women.

Can you have both?

It is possible to have both osteoporosis and osteomalacia. Low bone density that could be classified as osteoporosis has been found in up to 70 percent of people with osteomalacia.

It is important to distinguish this secondary osteoporosis from primary osteoporosis, as the focus and treatment are different.

Osteomalacia Osteoporosis
Symptoms may include:

easily fractured bones

muscle weakness and
bone pain, especially in the hips, which may spread to lower back

pelvis, legs, or ribs
muscle cramps
Osteoporosis is typically asymptomatic, especially early on, which is why it is often called a “silent” disease.

Until a bone is broken or a vertebrae collapses, you may not even know you have osteoporosis.
Low levels of calcium in the blood can also cause:

abnormal heart rhythms

numbness around the mouth or in the arms and legs

hand and foot spasms
Symptoms of a collapsed or broken vertebrae include hunched posture or severe back pain.

When bones reach a certain point of weakness from osteoporosis, they can break from minor falls or even normal stressors like lifting or coughing.

Diagnosis for each condition is a little different.

Osteomalacia diagnosis

For osteomalacia, a blood test can typically yield a diagnosis. The blood test measures:

  • calcium
  • phosphorus
  • vitamin D levels

Other blood tests may be ordered as well, including those to check for:

  • alkaline phosphatase, which is made by cells that make bone and is elevated in those with osteomalacia
  • parathyroid hormone, which is raised as a response to low vitamin D levels
  • an X-ray may show any small cracks or fractures in bone

Osteoporosis diagnosis

Osteoporosis is usually diagnosed during a routine screening for the condition. Routine screenings are done for women over age 65 years or women of any age who have certain risk factors.

Tools used in making a diagnosis include:

  • medical history, including previous fractures, lifestyle behaviors, and family history
  • physical exam, including balance, gait, and muscle strength
  • bone mineral density testing like a DXA scan

Bone mineral density testing can help:

  • find low bone density that can later lead to osteoporosis
  • diagnose osteoporosis
  • monitor the effectiveness of your osteoporosis treatments

It uses X-rays to measure the density of the bones.

Treatments for osteomalacia and osteoporosis also differ.

Osteomalacia treatments

If osteomalacia is found early enough, your doctor may recommend vitamin D, calcium, or phosphate supplements. Sometimes vitamin D is also given intravenously, or through an injection into the vein.

If you have an underlying medical condition that interferes with absorption of vitamin D, treating that condition is necessary as well.

Sometimes children with osteomalacia may need to wear braces or have surgery to fix any bone abnormalities.

Osteoporosis treatments

Treatment for osteoporosis focuses on slowing or stopping bone loss and preventing fractures.

It may consist of:

  • Nutritional changes. Helpful dietary tips include eating a variety of fruits and vegetables, adjusting your calorie intake, and ensuring you’re consuming enough calcium, vitamin D, and protein.
  • Lifestyle changes. Making changes such as considering quitting smoking if you smoke, reducing alcohol intake, and regular checkups with a medical professional are important in managing your condition and symptoms associated with it.
  • Incorporating exercise into your routine. You’ll want to focus specifically on strength or resistance training, including any specific exercises a physical therapist or rehabilitation specialist recommend.
  • Speaking with an occupational therapist. They can help you put fall prevention strategies into place.
  • Taking medication. Medications are also used to strengthen bones and prevent further bone loss. Medications include:
    • bisphosphonates
    • calcitonin
    • estrogen agonist/antagonist
    • estrogen and hormone therapy
    • parathyroid hormone analog and parathyroid hormone-related protein analog
    • RANK ligand (RANKL) inhibitor
    • Sclerostin inhibitor

Prevention also depends on the condition.

Osteomalacia prevention

Osteomalacia may not always be preventable, such as if it’s due to another medical condition. For osteomalacia that a lack of sun exposure or vitamin D deficiency causes, there are things you can do to reduce your risk.

Those include:

  • Eating foods high in vitamin D, such as:
    • oily fish
    • eggs
    • mushrooms
    • fortified foods like cereal, milk, yogurt, and bread
  • Taking supplements if necessary

Osteoporosis prevention

To reduce your risk for developing osteoporosis, there are steps you can take to help protect your bones, including:

  • getting enough calcium and vitamin D
  • eating a balanced diet
  • consuming foods that boost bone health like fruits and vegetables
  • considering quitting smoking, if you smoke and limiting alcohol intake to one to three drinks per day

If you have any risk factors for osteomalacia or osteoporosis talk with a healthcare professional. They may want to

  • monitor your situation more frequently
  • conduct screening tests
  • add specific supplements to your treatment plan
  • provide guidance on how to keep your bones healthy

If you have repeated fractures or symptoms of osteoporosis or osteomalacia, see your healthcare professional. Only they can make a diagnosis and provide you with appropriate treatment.

Osteomalacia and osteoporosis are serious diseases of the bone. Early and accurate diagnosis is important so you can get appropriate treatment and keep your bones as healthy as possible.

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