What is Osteomalacia?

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 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 turnover” and osteomalacia interferes with this very important process.To perform bone turnover, your bone needs

  • Minerals (calcium and phosphorus)
  • Bone protein matrix (osteoid, made up of collagen)
  • Osteoclasts (bone removing cells)
  • Osteoblasts (bone producing cells)
The Bone Turnover Cycle
Osteomalacia Interferes with the Bone Turnover Cycle image

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 increase risk of fracture.

What Causes 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 dietVitamin 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.
  • Lack of exposure to sunlight, which naturally generates vitamin D in the body. It’s the fastest way to replenish your vitamin D, regularly.  Getting sunlight on bare skin (no sunscreen) for just 15-20 minutes a day can produce as much as 15,000 – 20,000 IU’s of vitamin D3! Do this 3x a week and you’re off to a great start. But during the winter months or seasons when the sun isn’t available – you may want to consider supplementing.
  • Vitamin D absorption problems. If you suffer from Celiac disease (an autoimmune disorder) the lining of your small intestine is damaged. This makes it difficult to absorb nutrients, like vitamin D.

Other possible risk factors of osteomalacia

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

Osteomalacia Symptoms and Diagnosis

At the very early stages of osteomalacia, there may not be any symptoms at all.

But once it progresses, osteomalacia can cause bone pain and muscle weakness.  But because the symptoms are so numerous it is common to be misdiagnosed and confused with other conditions. Pain is most often felt in the legs, groin, upper thighs, knees and sometimes in the feet. In some cases pain will be the result of partial fractures, which are only visible on x-rays. Muscle weakness tends to affect the thighs and the muscles in the shoulders and main core of the body.

See how these symptoms could also be for other conditions? It makes it tricky.

To be sure, it’s important to get tested.

Osteomalacia can be diagnosed by x-ray and with a blood test that will measure levels of calcium, phosphorus and vitamin D. A blood test can also be measured for Alkaline phosphatase and parathyroid hormone levels.

Osteomalacia Treatment

In most cases osteomalacia is curable 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.


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