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What is osteomalacia?

Osteomalacia is a weakening of the bones. Problems with bone formation or the bone-building process causes osteomalacia.

This condition isn’t the same as osteoporosis. Osteoporosis is a weakening of living bone that’s already formed and being remodeled.

A lack of vitamin D is the most common cause of osteomalacia. Vitamin D is an important nutrient that helps you absorb calcium in your stomach.

Vitamin D also helps maintain calcium and phosphate levels to help your bones form properly. It’s made within the skin from exposure to ultraviolet (UV) rays in sunlight. It can also be absorbed from foods like dairy products and fish.

Your body can’t process the calcium your bones need to stay strong if you have low levels of vitamin D. A vitamin D deficiency can result from:

  • a problem with your diet
  • a lack of sun exposure
  • an issue with your intestines

You may also have a problem absorbing vitamin D or breaking down food to release it if you’ve had surgery to remove parts of your stomach or small intestine.

Certain conditions can interfere with the absorption of vitamin D:

  • Celiac disease can damage the lining of your intestines and prevent the absorption of key nutrients like vitamin D.
  • Certain types of cancer can interfere with vitamin D processing.
  • Kidney and liver disorders can affect the metabolism of vitamin D.

A diet that doesn’t include phosphates can cause phosphate depletion, which can also lead to osteomalacia. Drugs for treating seizures — like phenytoin and phenobarbital — can also result in osteomalacia.

There are a few symptoms of osteomalacia.

The most common is bones that fracture easily. Another is muscle weakness. This happens because of problems in the areas where muscle attaches to bone. A person with osteomalacia may have a hard time walking or may develop a waddling gait.

Bone pain, especially in your hips, is also a common symptom.

A dull, aching pain can spread from your hips to the following places:

  • lower back
  • pelvis
  • legs
  • ribs

If you also have very low levels of calcium in your blood, you may have:

Your healthcare provider will do a blood test to diagnose the condition. If it shows any of the following, you may have osteomalacia or another bone disorder:

  • low levels of vitamin D
  • low levels of calcium
  • low levels of phosphorus

Your healthcare provider may also test you for alkaline phosphatase isoenzymes. High levels indicate osteomalacia.

Another blood test can check your levels of parathyroid hormone. High levels of this hormone suggest insufficient vitamin D and other related problems.

X-rays and other imaging tests can show small cracks in your bones. These cracks are called Looser’s transformation zones. Fractures can begin in these zones even with small injuries.

Your healthcare provider may need to do a bone biopsy to diagnose osteomalacia. They’ll insert a needle through your skin and muscle and into your bone to get a small sample. They’ll put the sample on a slide and examine it under a microscope.

Usually, an X-ray and blood tests are enough to make a diagnosis, and a bone biopsy isn’t necessary.

If your healthcare provider detects osteomalacia early, you may only need to take oral supplements of vitamin D, calcium, or phosphate.

Shop for vitamin D and calcium supplements online.

This may be the first line of treatment if you have absorption problems due to intestinal injury or surgery, or if you have a diet low in key nutrients.

In rare cases, you can take vitamin D as an injection through your skin or intravenously through a vein in your arm.

You may need to spend some time outdoors in sunlight so your body can make enough vitamin D in your skin.

You may also need treatment if you have other underlying conditions that affect vitamin D metabolism. You need treatment for cirrhosis and kidney failure to reduce osteomalacia.

Children with severe cases of osteomalacia or rickets may have to wear braces or have surgery to correct bone deformation.

If you don’t treat the cause of your osteomalacia, there are complications. Adults can fracture bones easily such as rib, leg, and spine bones.

Also, in children, osteomalacia and rickets often occur together, which can lead to bowing of the legs or premature tooth loss.

Symptoms can return if not enough vitamin D is available. They’ll also return if you stop taking supplements or if you don’t address underlying conditions like kidney failure.

Talk to your healthcare provider to create a treatment plan based on your healthcare needs.

If left untreated, osteomalacia can lead to broken bones and severe deformity.

There are various treatment options available to help manage the conditions.

You may see improvements in a few weeks if you increase your intake of vitamin D, calcium, and phosphorus.

Complete healing of the bones takes about 6 months.