Osteomalacia is a weakening of the bones. Problems with bone formation or the bone-building process causes osteomalacia.
This condition isn’t the same as osteoporosis. Osteoporosis is a weakening of living bone that is already formed and being remodeled.
Vitamin D also helps maintain calcium and phosphate levels so your bones form properly. It’s made within the skin from exposure to ultraviolet (UV) rays in sunlight. It can also be absorbed from foods like dairy products and fish.
Your body can’t process the calcium your bones need to stay strong if you have low levels of vitamin D. This can result from a problem with diet, a lack of sun exposure, or an issue with your intestines.
You may also have a problem absorbing vitamin D or breaking down food to release it if you’ve had surgery to remove parts of your stomach or small intestine.
Certain conditions can interfere with the absorption of vitamin D:
- Celiac disease can damage the lining of your intestines and prevent the absorption of key nutrients like vitamin D.
- Certain types of cancer can interfere with vitamin D processing.
- Kidney and liver disorders can affect the metabolism of vitamin D.
A diet that doesn’t include phosphates can cause phosphate depletion, which can also lead to osteomalacia. And drugs to treat seizures — like phenytoin and phenobarbital — can also result in osteomalacia.
There are a few symptoms of osteomalacia. The most common is bones that fracture easily. Another is muscle weakness. This happens because of problems in the areas where muscle attaches to bone. A person with osteomalacia may have a hard time walking or develop a waddling gait.
Bone pain, especially in your hips, is also a common symptom. A dull, aching pain can spread from your hips to the following places:
- lower back
If you also have very low levels of calcium in your blood, you may have:
- irregular heart rhythms
- numbness around your mouth
- numbness in your arms and legs
- spasms in your hands and feet
To reach a diagnosis, your doctor will do a blood test. If it shows any of the following, you may have osteomalacia or another bone disorder:
- low levels of vitamin D
- low levels of calcium
- low levels of phosphorus
Your doctor may also test you for alkaline phosphatase isoenzymes. High levels indicate osteomalacia. And another blood test can check your levels of parathyroid hormone. High levels of this hormone suggest insufficient vitamin D and other related problems.
X-rays and other imaging tests can show small cracks in your bones. These cracks are called Looser’s transformation zones. Fractures can begin in these zones even with small injuries.
Your doctor may need to do a bone biopsy to diagnose osteomalacia. They will insert a needle through your skin and muscle and into your bone to get a small sample. They will put the sample on a slide and examine it under a microscope.
Usually, an X-ray and blood tests are enough to make a diagnosis, and a bone biopsy isn’t necessary.
This may be the first line of treatment if you have absorption problems due to intestinal injury or surgery, or if you have a diet low in key nutrients. In rare cases, you can take vitamin D as an injection through your skin or intravenously through a vein in your arm. And you may need to spend some time outdoors in sunlight so your body can make enough vitamin D in your skin.
Children with severe cases of osteomalacia or rickets may have to wear braces or have surgery to correct bone deformation
Symptoms can return if not enough vitamin D is available. They’ll also return if you stop taking supplements or if you don’t address underlying conditions like kidney failure. Talk to your doctor to create a treatment plan.
Osteomalacia will lead to many broken bones and severe deformity if you don’t treat it.
You may see improvements in a few weeks if you increase your intake of vitamin D, calcium, and phosphorus. Complete healing of the bones takes about six months.