Osteomalacia is softening of the bones due to a lack of vitamin D or a problem with the body's ability to break down and use this vitamin.

Complications of Osteomalacia

If you have osteomalacia, you're more likely to experience broken bones, particularly in your ribs, spine and legs.

Causes of Osteomalacia

The softer bones seen in persons with osteomalacia have a normal amount of collagen, which gives the bones its structure, but lack the proper amount of calcium.

There are numerous causes of osteomalacia. In children, the condition is called rickets and is usually caused by low levels of vitamin D.

Other conditions that may lead to osteomalacia include:

• Not enough vitamin D in the diet
• Not enough exposure to sunlight, which produces vitamin D in the body
• Malabsorption of vitamin D by the intestines

Use of very strong sunscreen, limited exposure of the body to sunlight, short days of sunlight and smog are factors that reduce formation of vitamin D in the body. The elderly and those who avoid drinking milk are at increased risk for osteomalacia.

Other conditions that may cause osteomalacia include:

• Cancer
• Hereditary or acquired disorders of vitamin D metabolism
• Kidney failure and acidosis
• Liver disease
• Phosphate depletion associated with not enough phosphates in the diet
• Side effects of medications used to treat seizures

Signs & Symptoms of Osteomalacia

In the early stages, you may have no osteomalacia symptoms, although signs of osteomalacia may be apparent on X-ray pictures or other diagnostic tests. As osteomalacia worsens, you may experience bone pain and muscle weakness.

Bone pain

The dull, aching pain associated with osteomalacia most commonly affects the:

• Lower spine
• Pelvis
• Legs

Muscle weakness

Osteomalacia may result in:

• Decreased muscle tone
• Weakness in your arms and legs
• Reduced ability to get around
• A waddling gait

Diagnosis of Osteomalacia

In order to pinpoint the underlying cause of osteomalacia and to rule out other bone disorders, such as osteoporosis, you may undergo one or more of the following tests:

• Blood and urine tests. In cases of osteomalacia caused by vitamin D deficiency or by phosphorus loss, abnormal levels of vitamin D and the minerals calcium and phosphorus are often detected.
• X-ray. Slight cracks in your bones that are visible on X-rays, referred to as Looser transformation zones, are a characteristic feature of people with osteomalacia.
• Bone biopsy. During a bone biopsy, your doctor inserts a slender needle through your skin and into your bone to withdraw a small sample for viewing under a microscope. Although a bone biopsy is very accurate in detecting osteomalacia, it's not often needed to make the diagnosis.

Treatments of Osteomalacia

• Treatment may involve vitamin D, calcium, and phosphorus supplements, taken by mouth. Larger doses of vitamin D and calcium may be needed for people who cannot properly absorb nutrients into the intestines.
• Regular blood tests may be needed to monitor blood levels of phosphorus and calcium in persons with certain underlying conditions.

Prevention of Osteomalacia

Osteomalacia caused by inadequate sun exposure or a diet low in vitamin D often can be prevented. Here are a few suggestions to help reduce your risk of developing osteomalacia:

• Spend a few minutes in the sun. For most people, 15 minutes of direct sun exposure a couple of times a week is sufficient for proper vitamin D production.
• Eat foods high in vitamin D. These include foods that are naturally rich in vitamin D, including oily fish (salmon, mackerel, sardines) and egg yolks. Also look for foods that are fortified with vitamin D, such as cereal, bread, milk and yogurt.
• Take supplements, if needed. If you don't get enough vitamins and minerals in your diet or if you have a medical condition affecting the ability of your digestive system to absorb nutrients properly, ask your doctor about taking vitamin D and calcium supplements.

When to seek Medical Advice

Call for an appointment with your health care provider if you have symptoms of osteomalacia, or if you think that you may be at risk for this disorder.