Overview

Osteomalacia refers to a marked softening of your bones, most often caused by severe vitamin D deficiency. The softened bones of children and young adults with osteomalacia can lead to bowing during growth, especially in weight-bearing bones of the legs. Osteomalacia in older adults can lead to fractures.

Treatment for osteomalacia involves providing enough vitamin D and calcium, both required to harden and strengthen bones, and treating disorders that might cause the condition.

Symptoms

When osteomalacia is in its early stages, you might not have symptoms, although signs of osteomalacia might show on an X-ray or other diagnostic tests. As osteomalacia progresses, you might develop bone pain and muscle weakness.

The dull, aching pain associated with osteomalacia most commonly affects the lower back, pelvis, hips, legs and ribs. The pain might be worse at night or when you put pressure on the bones. The pain is rarely relieved completely by rest.

Decreased muscle tone and leg weakness can cause a waddling gait and make walking slower and more difficult.

Causes

Osteomalacia results from a defect in the bone-maturing process. Your body uses the minerals calcium and phosphate to help build strong bones. You might develop osteomalacia if you don't get enough of these minerals in your diet or if your body doesn't absorb them properly. These problems can be caused by:

• Vitamin D deficiency. Sunlight produces vitamin D in your skin. Dietary vitamin D is usually from foods to which the vitamin has been added, such as cow's milk.

  People who live in areas where sunlight is limited, get little exposure to sunlight or eat a diet low in vitamin D can develop osteomalacia. Vitamin D deficiency is the most common cause of osteomalacia worldwide.

• Certain surgeries. Normally, the stomach breaks down food to release calcium and other minerals that are absorbed in the intestine. This process is disrupted if you have surgery to remove part or all of your stomach or to bypass your small intestine and can result in vitamin D and calcium deficiency.
• Celiac disease. In this autoimmune disorder, foods containing gluten, a protein found in wheat, barley and rye, can damage the lining of your small intestine. A damaged intestinal lining doesn't absorb nutrients well, and can lead to vitamin D and calcium deficiency.
• Kidney or liver disorders. These organs are involved in activating vitamin D in your body. Problems with your kidneys or liver can affect your body's ability to make active vitamin D.
• Drugs. Some drugs used to treat seizures, including phenytoin (Dilantin, Phenytek) and phenobarbital, can cause severe vitamin D deficiency and osteomalacia.

Risk factors

The risk of developing osteomalacia is highest in people who don't get enough dietary vitamin D and have little sun exposure, such as older adults and those who are housebound or hospitalized.

Complications

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

Prevention

Osteomalacia caused by inadequate sun exposure or a diet low in vitamin D often can be prevented by getting enough vitamin D.

• Eat foods high in vitamin D. Foods naturally rich in vitamin D include oily fish (salmon, mackerel, sardines) and egg yolks. Also look for foods 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 that keeps your digestive system from absorbing nutrients properly, ask your doctor about taking vitamin D and calcium supplements.

Unprotected sun exposure can increase your risk of skin cancer. There's no consensus among experts about what amount of sun exposure is safe and enough to prevent or treat osteomalacia.

Diagnosis

Osteomalacia can be difficult to diagnose. To pinpoint the cause and to rule out other bone disorders, such as osteoporosis, you might undergo one or more of the following tests:

• Blood and urine tests. These help detect low levels of vitamin D and problems with calcium and phosphorus.
• X-rays. Structural changes and slight cracks in your bones that are visible on X-rays are characteristic of osteomalacia.
• Bone biopsy. Using general anesthesia, a surgeon inserts a slender needle through your skin and into your pelvic bone above the hip to withdraw a small sample of bone. Although a bone biopsy is accurate in detecting osteomalacia, it's rarely needed to make the diagnosis.

Treatment

Fortunately, getting enough vitamin D through oral supplements for several weeks to months can cure osteomalacia. To maintain normal blood levels of vitamin D, you'll likely have to continue taking the supplements.

Your health care provider might also recommend that you increase your calcium or phosphorus intake, either through supplements or diet. Treating conditions that affect vitamin D metabolism, such as kidney and liver disease or low phosphate levels, often helps improve the signs and symptoms of osteomalacia.

Preparing for an appointment

You'll likely start by seeing your primary care provider, who might refer you to a doctor who specializes in diseases of the joints and muscles (rheumatologist) or one who specializes in metabolic bone disorders (endocrinologist).

Make a list of:

• Your symptoms, including any that seem unrelated to your reason for making the appointment, and when they began
• Key personal information, including other medical conditions and family medical history
• All medications, vitamins and other supplements you take, including doses
• Questions to ask your doctor

For osteomalacia, basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• What tests do I need?
• What treatment do you recommend?
• Do I need to change my diet or lifestyle?
• Am I at risk of long-term complications from this condition?
• Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, including:

• Where do you feel pain?
• When did your pain start, and has it progressed?
• Are any areas tender to the touch?
• Is your pain constant or does it come and go?
• Does anything make your symptoms better or worse?
• Have you had gastric bypass surgery or other bowel surgery?
• What treatments have you tried so far, if any? Has anything helped?