Osteomalacia

Osteomalacia is softening of the bones. It most often occurs because of a problem that leads to vitamin D deficiency, which helps your body absorb calcium. Your body needs calcium to maintain the strength and hardness of your bones.

Vitamin D

Vitamin D is a fat-soluble vitamin. Fat-soluble vitamins are stored in the body's fatty tissue and liver.

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In children, the condition is called rickets.

Rickets

Rickets is a disorder caused by a lack of vitamin D, calcium, or phosphate. It leads to softening and weakening of the bones.

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Causes

A lack of the proper amount of calcium in the blood can lead to weak and soft bones. Low blood calcium can be caused by low vitamin D level in the blood.

Vitamin D is absorbed from food or produced by the skin when exposed to sunlight. Lack of vitamin D produced by the skin may occur in people who:

• Live in climates with little exposure to sunlight
• Must stay indoors
• Work indoors during the daylight hours
• Wear clothes that cover most of their skin
• Have dark skin pigmentation
• Use very strong sunscreen

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

• Are lactose intolerant (have trouble digesting milk products)
• Do not eat or drink milk products (more common in older adults)
• Follow a vegetarian diet
• Are not able to absorb vitamin D well in the intestines, such as after gastric bypass surgery or due to a gastrointestinal disease

Other conditions that may cause osteomalacia include:

• Cancer -- rare tumors that cause low phosphate level in the blood
• Kidney failure and acidosis

  Kidney failure

  Acute kidney failure is the rapid (less than 2 days) loss of your kidneys' ability to remove waste and help balance fluids and electrolytes in your b...

  

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  Acidosis

  Acidosis is a condition in which there is too much acid in the body fluids. It is the opposite of alkalosis (a condition in which there is too much ...

  

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• Lack of enough phosphates in the diet
• Liver disease -- the liver cannot convert vitamin D to its active form
• Side effects of medicines used to treat seizures

  Seizures

  A seizure is the physical changes in behavior that occurs during an episode of specific types of abnormal electrical activity in the brain. The term ...

  

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Symptoms

Symptoms include:

• Bone fractures that happen without a significant injury
• Muscle weakness

  Muscle weakness

  Weakness is reduced strength in one or more muscles.

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• Widespread bone pain, especially in the hips

  Bone pain

  Bone pain or tenderness is aching or other discomfort in one or more bones.

  

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Symptoms may also occur due to a low calcium level. These include:

• Numbness around the mouth

  Numbness

  Numbness and tingling are abnormal sensations that can occur anywhere in your body, but they are often felt in your fingers, hands, feet, arms, or le...

  

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• Numbness or tingling of the arms and legs
• Spasms or cramps of the hands or feet

  Spasms or cramps of the hands or feet

  Spasms are contractions of the muscles of the hands, thumbs, feet, or toes. Spasms are usually brief, but they can be severe and painful.

  

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Exams and Tests

Blood tests will be done to check vitamin D, creatinine, calcium, phosphate, electrolyte, alkaline phosphatase, and parathyroid hormone levels.

Phosphate

The phosphorus blood test measures the amount of phosphate in the blood.

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Bone x-rays and a bone density test can help detect pseudofractures, bone loss, and bone softening. More importantly, osteomalacia can look like weakening of the bones from osteoporosis on bone density testing.

Bone x-rays

A bone x-ray is an imaging test to look at the bones.

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Bone density test

A bone mineral density (BMD) test measures how much calcium and other types of minerals are in an area of your bone. This test helps your health care...

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Osteoporosis

Osteoporosis is a disease in which bones become fragile and more likely to break (fracture).

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In some cases, a bone biopsy will be done to see if bone softening is present.

Bone biopsy

A bone lesion biopsy is the removal of a piece of bone or bone marrow for examination.

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Treatment

Treatment may involve vitamin D, calcium, and phosphorus supplements taken by mouth. People who cannot absorb nutrients well through the intestines may need larger doses of vitamin D and calcium. This includes people who have some types of weight loss surgery.

People with certain conditions may need regular blood tests to monitor blood levels of phosphorus and calcium.

Outlook (Prognosis)

Some people with vitamin deficiency disorders will get better within a few weeks. With treatment, healing should happen within 6 months.

Possible Complications

Symptoms can return.

When to Contact a Medical Professional

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

Prevention

Eating a diet rich in vitamin D and calcium and getting sufficient exposure to sunlight can help prevent osteomalacia due to vitamin D deficiency.