Osteomalacia is a metabolic disease that causes weakened bones. It is similar to rickets in children, which causes pain, soft bones, and can lead to bone deformities. People with osteomalacia have problems forming new bone. The condition is different than osteoporosis, which occurs when existing bone becomes weak and soft. This disease can be uncomfortable and may be experienced alongside, or develop due to, other health conditions. Fortunately, many cases are highly treatable.

Causes of Osteomalacia

Vitamin D deficiencies usually cause osteomalacia. The nutrient is vital to the absorption of calcium from food, which in turn keeps bones strong and helps new bone form normally. The most likely reason for vitamin D deficiency is a lack of foods enriched with the nutrient. However, inadequate exposure to sunlight is another possible cause — the body can synthesize its own vitamin D after spending time in the sun.

Associated Conditions

Certain health conditions can make insufficient vitamin D, and therefore osteomalacia, more likely. Celiac disease can damage the intestinal lining and stop one from adequately absorbing key nutrients, including vitamin D. Disease of the kidneys or liver can also prevent the body from metabolizing vitamin D. Some cancers can impair the body’s ability to process the vitamin. People who have had surgery to remove part of their stomach or intestine are more likely to develop this condition.

Common Symptoms

Osteomalacia causes the bones to fracture easily and can result in muscle weakness because of poor muscle to bone attachment. People with the condition may have difficulty walking and develop an unusual gait. Many people with this disease experience pain in their bones that is most frequently felt in the back, pelvis, legs, and ribs. This pain is usually described as dull and aching.

Symptoms of Low Calcium Levels

People with osteomalacia usually have low levels of calcium in their blood, which can lead to calcium deficiency. One of the most common signs is an irregular heart rhythm. Calcium deficiency can also cause problems with sensation. Many people with osteomalacia will experience numbness in their hands and feet or around the mouth. Some people have muscular spasms in their hands or feet.

Diagnosing Osteomalacia

If a doctor suspects osteomalacia, they are likely to order blood tests to check nutrient levels in the body. If the tests show a deficiency in vitamin D, calcium, or phosphorus, this indicates the presence of this disease or another bone disorder. X-rays can also be sued to diagnose it. The scans may show small cracks in the bone known as Looser’s transformation zones. These cracks can become fractures following even very minor injuries.

Bone Biopsy

Some people may require a bone biopsy to diagnose osteomalacia. The doctor will extract a sample of the bone tissue with a biopsy needle. Unlike a bone marrow biopsy, the sample requires only the outer layer of the bone. The doctor will then examine the sample under a microscope to check for signs of osteomalacia. This is a rare diagnosis requirement, however; blood tests and x-rays are usually adequate.

Treatment Options

Treatment for osteomalacia depends on the severity of the condition and its cause. If the person only has a mild case and doctors catch it early, he or she may only require dietary supplements. The doctor may recommend extra vitamin D, calcium, or phosphorus if the person has nutrient absorption problems or has had surgery on their digestive tract. In rare cases, the person may require intravenous supplements or the physician may suggest they spend time outdoors in the sunlight. If an underlying illness such as kidney disease is causing osteomalacia, treating the pre-existing issue can alleviate the symptoms of the secondary condition.

Complications

People with osteomalacia can experience frequent and serious fractures and may develop bone deformities. This is particularly likely if the condition is advanced or the affected person is a child. Children with serious osteomalacia may need to wear bone braces or have surgery to prevent deformity and ensure the bones develop normally.

Prognosis

Most people who increase their intake of vitamin D or supplement their diet with additional calcium or phosphorus will experience improvement in their condition within a few weeks. It can take around six months for the bones to heal completely and return to normal after beginning to treat osteomalacia. If the affected person stops taking their supplements when they start feeling better, it is highly likely their nutrient levels will again become too low, and their osteomalacia will return.

Prevention

People can prevent osteomalacia by consuming a diet rich in vitamin D, which is available from eggs, dairy products, liver, and fortified foods such as bread and breakfast cereal. Spending time outside in the sunlight can also prevent vitamin D levels from falling too low.  Those with conditions likely to interfere with nutrient absorption or who have had gastrointestinal surgery may need to take supplements as a preventative measure.