Osteomalacia: Causes, Symptoms, Diagnosis and Treatment

Senior couple in gym doing weight bearing exercise

Osteomalacia or “soft bones” is a condition that affects your bones and is most often due to a lack of vitamin D and sometimes due to a mineral deficiency. When found in children, this condition is called rickets. Nowadays it is rare to see rickets, but osteomalacia is still a threat to adults.

Osteomalacia interferes with new bone formation or the production of osteoblasts (bone cells). The human body is constantly removing old bone and replacing it with new bone. This is called “bone remodeling” and osteomalacia interferes with this very important process. To perform bone remodeling, your bone needs…

  • Minerals (calcium and phosphorus)
  • Bone protein matrix (osteoid, made up of collagen)

Osteoid is the bone protein matrix and when there is insufficient mineral or osteoblast dysfunction, the collagen in the osteoid does not mineralize properly, and it accumulates. If bone is made up of more collagen than minerals, bones become soft and increased risk of fracture.

  • Osteoclasts (bone removing cells)
  • Osteoblasts (bone producing cells)

The Bone Remodeling Cycle

Your bones are dynamic tissues that are constantly undergoing the remodeling process. Old bone is resorbed by osteoclasts and new bone is laid down by osteoblasts. This necessary process acts to repair bone microdamage that occurs normally through daily activity. It also acts to replace bone during the growth process and following fractures.

This back and forth signaling between osteoblasts and osteoclasts is crucial for this process to work and be effective.

bone remodeling cycle

  • Resting: The resting stage is when the bone surface is inactive and covered by bone lining cells.
  • Activation: This stage exposes pre-osteoclasts to the mineralized bone surface. These pre-osteoclasts are recruited and taken to the resorption site.
  • Resorption: When osteoclasts make contact with the bone surface they become active and begin the resorption stage of the cycle.
  • Reversal: Once the resorption stage is complete, there is a period of about 1-2 weeks before formation begins and is called reversal.
  • Formation: This stage happens in two stages. First is the synthesis of bone matrix by osteoblasts. Second, is the subsequent mineralization of the matrix.

* If there is an imbalance between the resorption and formation stage, it can lead to bone loss and diseases such as osteoporosis and osteomalacia.

What Are The Causes and Risk Factors of Osteomalacia?

Bone mineralization requires adequate minerals (calcium, phosphorus and vitamin D). Inadequate amounts of any one of these will develop into osteomalacia. Here is a list of the known causes of osteomalacia.

Lack Of Vitamin D In Diet

Vitamin D3 is a difficult vitamin to get adequate amounts from diet alone. For instance, a 3-ounce sockeye salmon filet only contains about 450 IU of vitamin D3. Some mushrooms, like Portobello, will give you 400 IU of vitamin D3 per 3-ounce portion. Not entirely insignificant, but not enough.

You may not get enough vitamin D from your diet if you:

  • Are lactose intolerant or are sensitive to dairy ( where you have trouble digesting milk products)
  • Do not eat or drink milk products (more common in older adults)
  • Follow a vegetarian diet (Fish, organ meats, and eggs are high on the list of vitamin D food sources)
  • Are not able to absorb vitamin D well in the intestines, such as after gastric bypass surgery.

Lack Of Exposure To Sunlight 

The latitude of where you live plays a role in the amount of vitamin D-producing UVB light that reaches the earth’s surface. This is crucial during the winter months or seasons when the sun isn’t as readily available because of the low angle of the sun. In Boston for example, little if any vitamin D is produced by the skin during the months of November through February. Take into consideration shorter days and clothes covering skin, which also limits the UVB exposure.

That doesn’t mean if you are living in lower latitudes that you’re off the hook. Individuals living in relatively sunny environments are still at risk for vitamin D insufficiency. Studies in South Florida, South Arizona, and Hawaii found significant levels of the population had low vitamin D levels, despite abundant sun exposure.

Factors that can undermine vitamin D production include:

  • Desk jobs: Where one is working indoors during daylight hours.
  • Skin color: Those with darker skin are more likely to have lower levels of vitamin D.
  • Use of sunscreen – in theory: Sunscreen is used to block the UVB light and prevent sunburn. However, an often-cited Australian study showed that during an Australian summer, there was no difference in the vitamin D levels of adults who were randomly assigned sunscreen compared to those who were assigned the placebo cream.
  • Vitamin D Absorption Problems – The health of your gut can influence the amount of vitamin D you can absorb. If you suffer from Celiac disease, Crohn’s disease, cystic fibrosis and chronic pancreatitis your vitamin D absorption may be reduced. In addition to your gut and digestion playing a role in vitamin D absorption. The following are also factors that influence vitamin D status:

Liver and Kidney Health

Some types of liver disease can reduce vitamin D absorption while other types block essential steps for vitamin D metabolism to occur.

Certain Drugs

Common drugs used to treat seizures such as phenytoin and phenobarbital and cholestyramine and colestipol for hypercholesterolemia inhibit vitamin D absorption.

Specific Surgeries

Gastric bypass surgery not only reduces the size of your stomach but also your ability to absorb nutrients. Furthermore, it eliminates your ability to absorb fat-soluble vitamins D and K.

Phosphate Deficiency

A diet lacking phosphates can cause phosphate depletion and lead to osteomalacia. Foods high in phosphorous are pumpkin seeds, brazil nuts, romano cheese, and salmon. Blood tests can be done to test your vitamin D and phosphate levels.

mineral deficiency

Risk Factors For Osteomalacia

  • Hereditary vitamin D metabolism disorders
  • Kidney failure
  • Mineral deficiency
  • Cancer
  • Liver disease

What are the Symptoms of Osteomalacia?

At the very early stages of osteomalacia, there may not be any symptoms at all. But once it progresses, osteomalacia can cause individuals to waddle (with a side-to-side stride). In addition, one may experience…

  • Fractured bones due to minimal trauma
  • Lethargy
  • Stiffness
  • Muscle Weakness: Muscle weakness tends to affect the thighs and the muscles in the shoulders and main core of the body.
  • Difficulty walking up stairs or getting up from a seated position.
  • Bone Pain: Such as dull aches, especially in your hips. Pain is most often felt in the legs, groin, upper thighs, knees and sometimes in the feet. In some cases, the pain will be the result of partial fractures, which are only visible on x-rays.

If you have low blood calcium levels, you may also experience:

  • Hand and foot spasms
  • Irregular heart rhythms
  • Numbness in your legs and arms
  • Numbness around your mouth

However, the symptoms can often be confused with other conditions and lead to osteomalacia being misdiagnosed frequently.

How is Osteomalacia Diagnosed?

See how these symptoms could also be for other conditions? It makes it tricky. So to be sure, it’s important to get tested.

Osteomalacia can be diagnosed by:

  • X-Ray – Slight cracks in your bones that are visible on X-rays are characteristic of osteomalacia.
  • Blood Tests – These tests will measure low levels of calcium, phosphorus, electrolytes and vitamin D in your system. A blood test can also be measured for Alkaline phosphatase isoenzymes and parathyroid hormone levels. High levels of these indicate osteomalacia.
  • Bone Biopsy. This is a test where a small sample of your bone is removed. Although accurate, it’s rarely needed to make the diagnosis for osteomalacia.

Girl smells sunflower in the sun - vitamin D

What Are the Available Treatments for Osteomalacia?

Osteomalacia is often caused by a lack of vitamin D and sometimes mineral deficiencies. To treat osteomalacia, naturally, you need to:

  • Eat Vitamin D Rich Foods: Cold water fatty fish like salmon, sardines and tuna, eggs, liver and fortified foods like cereal, milk, and yogurt are some of the top food sources of vitamin D.
  • Treat the cause: If your body has a difficult time absorbing vitamin D and other nutrients, you need to discover the root cause and hopefully, treat it. Most likely, you’ll need to take larger doses of calcium and vitamin D.
    • Supplement: Changes in diet and lifestyle will positively affect your bones, but make sure to supplement for any shortfall they may have. AlgaeCal Plus is clinically proven to increase bone density in as little as 6 months – at any age! It contains ALL 13 known essential bone supporting minerals, including calcium from a plant source. And AlgaeCal Plus also provides vitamins C, D3, and K2. Osteomalacia is often caused by lack of vitamin D, but can also be due to other mineral deficiencies. Protect yourself and your bones starting today.





Osteomalacia FAQs

Is osteomalacia curable?

In most cases, osteomalacia can be treated through increased intake of vitamin D, calcium, and other bone-building nutrients. It is always best to get these minerals from your diet, but daily supplements of vitamin D and calcium will be required as an osteomalacia treatment.

What can I expect in the long term?

Osteomalacia left untreated may lead to an increased risk of broken bones and severe deformity.

What are the potential complications of osteomalacia?

Easily fracturing bones, muscle weakness, stiffness and difficulty walking. All these symptoms, including others, can return if sufficient vitamin D and other minerals are not adequate. If you have other underlying health conditions like liver disease or kidney disease it may also lead to further bone loss to inhibited vitamin D and nutrient absorption.

How serious is osteomalacia?

Osteomalacia puts you at an increased risk of fracture and, if left untreated, can lead to lower bone density and osteoporosis. It may also be a sign of other underlying health conditions that affect nutrient absorption.

How common is osteomalacia?

Osteomalacia may be misdiagnosed and/or underdiagnosed because its symptoms present themselves like other diseases. However, in developed countries, it is reported that osteomalacia affects 1 in 1000 people.

How common is osteomalacia in the elderly?

In the elderly, osteomalacia prevalence is higher in women than in men and in those 80 years and over, compared to those that are younger than 80 years.

How is osteomalacia different from rickets?

Both these disorders are caused by vitamin D insufficiency. However, rickets is the name that is referred to when it occurs in children, where osteomalacia is referred to in adults.

How does osteomalacia differ from osteoporosis?

Osteomalacia refers to bones that are soft, while osteoporosis refers to bones that are weak and brittle.

How long does it take to recover from osteomalacia?

Prognosis is good for osteomalacia if the underlying issues are addressed. However, depending on the individual, recovery time will vary and can take weeks or months for bones to recover.

What is Oncogenic Osteomalacia?

Also known as tumor-induced osteomalacia (TIO), it is a rare paraneoplastic syndrome in which patients present with fractures, muscle weakness, and bone pain. The causes are high blood levels of the vitamin D-regulating hormone, identified phosphonate, and a protein called fibroblast growth factor 23 (FGF23), which is produced in bone cells.

Who is at risk for osteomalacia?

Individuals who are vitamin D, phosphate and/or mineral deficient are at an increased risk of osteomalacia. Individuals who have darker skin, get very little sun exposure, take certain medications, and have conditions that inhibit vitamin D absorption such as Celiac disease, Crohn’s and some types of kidney and liver disease.

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