Symptoms and Causes of Osteomalacia and Treatments

Osteomalacia is a disorder that causes a characteristic "waddling" gait due to bone pain and muscle weakness. Today's article will explain why it happens.
Symptoms and Causes of Osteomalacia and Treatments

Last update: 03 September, 2021

Osteomalacia is a disease that affects bone metabolism due to a decrease in the mineralization of osseous matter.

Bones are made up of cells called osteocytes and a mineralized cellular matrix. This matrix is what makes them hard and gives them structure. This is why the tissue of a person with osteomalacia softens due to a vitamin D deficiency.

As you can imagine, this condition increases the risk of fractures. Continue reading as today’s article will describe everything you need to know about osteomalacia, its symptoms, and treatments.

What exactly is osteomalacia?

As we mentioned above, this is a bone metabolism disorder. According to an article by Sociedad Española de Medicina Interna, it refers to a softening of the bones. In other words, a decrease in the process of bone mineralization.

The main cause of this disorder is vitamin D deficiency. Bone mineralization is a process that takes place thanks to calcium and phosphorus, which we obtain through the diet.

Vitamin D must do its thing in order to absorb it at the intestinal level. It’s a hormone that synthesizes in the skin and kidneys. Thus, it requires a certain amount of sunlight daily in order to activate.

This is why lack of enough sun exposure leads to the lack of action of this vitamin. Thus, the intestine doesn’t absorb enough calcium, which is necessary for bone mineralization.

Osteomalacia is more common in older people. In fact, this disorder is called rickets in children. The main difference lies in the fact that this situation alters the proper development of cartilage during childhood.

Symptoms of osteomalacia

This condition is actually asymptomatic but there may be bone pain and pronounced muscle weakness as it progresses.

According to Mayo Clinic specialists, the pain affects the lower back, pelvis, and hips. It can also appear in the legs or ribs. It worsens at night and neither rest nor common painkillers can decrease it.

Muscle weakness is due to a gradual loss of muscle tone. In fact, one of the most characteristic signs is the so-called waddling gait. It refers to a strange way of walking, as a result of pain and weakness.

In addition to these symptoms, the main problem of osteomalacia is that it increases the risk of fractures. This is because the bones are much more fragile and any trauma can lead to breakage.

A bowl of vitamin D.
Vitamin D activates naturally with the sun’s rays but there are also artificial supplements.

Causes and risk factors

Osteomalacia occurs due to a faulty process of bone mineralization. Earlier we mentioned that the main cause is vitamin D deficiency, but there are others.

Vitamin D deficiency can be due to low sun exposure or a diet low in this nutrient. Other causes include kidney or liver disorders. You’re probably already aware that the liver and the kidney are essential for the body to synthesize and activate the vitamin.

This is why it’s important to keep in mind that osteomalacia could also be secondary to intestinal surgeries. The intestine absorbs calcium and phosphorus; therefore, their absorption is altered after surgical removal of part of the intestine.

The same goes for celiac disease. This autoimmune condition progressively damages the intestinal lining, reducing the absorption capacity.

Risk factors

Numerous factors increase the risk of osteomalacia. According to a publication by Versus Arthritis, this risk is higher in older people. This is because they have little exposure to the sun, especially those who are hospitalized or housebound.

In addition, it seems that Asians, especially Hindus, are also an at-risk population. The same is true for anyone who wears clothing that covers a large part of their skin during the day (such as the women who wear a burqa).

Pregnant women and children have higher vitamin D requirements. It is, therefore, essential that they get sufficient amounts as they’re a population at risk for osteomalacia and/or rickets.

Diagnosing osteomalacia

This is a difficult disorder to diagnose so it’s important for the physician to review the existing medical literature. They must learn as much as they can about symptoms, underlying problems, and any other factors that can guide them. This is because a physical examination is highly variable and non-specific.

Certain complementary tests usually help confirm the diagnosis.

  • Firstly, a blood test to measure calcium, phosphorus, and vitamin D levels
  • Urinalysis can also be helpful and doctors can use it to study kidney function as it can reveal increased calcium or phosphorus excretion
  • Imaging tests are essential as they can reveal bone fractures due to a decrease in bone density similar to that of osteoporosis


Treating osteomalacia is quite simple. According to an article by the Cleveland Clinic, providing an adequate amount of vitamin D in the body is all it takes. One can also use oral supplements or injections for this purpose.

Physicians often recommend an increase in the intake of calcium and phosphorus. Doing so through the diet would be ideal, but artificial supplements can also provide these nutrients. Osteomalacia with kidney disease as the underlying cause requires immediate treatment.

Surgery may be required in those with bone deformities or fractures. Bracing can reduce the risk in patients with major problems.

A person holding a bunch of pills.
Calcium supplements are of little use if there’s not enough vitamin D as it impairs absorption.

Prevention and general recommendations

Osteomalacia is preventable, in most cases. This is because a high percentage is due to a vitamin D deficiency. This is usually a consequence of a diet with a low vitamin D content or a lack of sun exposure.

As you can see, you must try to adhere to a wholesome diet. Foods such as fish and eggs must be a part of it. However, you can also resort to supplements if you don’t get enough vitamin D from your diet. You must always do so under medical supervision.

Finally, you must try to increase sun exposure. Go out for a walk or exercise outdoors without too many layers of clothing. However, take precautionary measures to avoid sunburn and to avoid going out in the midday hours.

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