13017 Osteomalacia

Overview

Osteomalacia is a condition in which your bones become soft and weak because they lack the minerals they need to stay hard. It is most often caused by not getting enough vitamin D, which helps your body absorb bone-building minerals like calcium.

Osteomalacia is rare in countries where there is plenty of sunlight and foods are often fortified with vitamin D. However, it can still happen, especially in people who rarely go outdoors, older adults, and people with certain digestive or kidney conditions.

It can affect anyone, but it is more common in adults – especially older people, people with very limited sun exposure, people with darker skin, and those who have had weight-loss surgery or have conditions such as coeliac disease or inflammatory bowel disease.

Symptoms

Common symptoms

• Bone aches and tenderness, especially in the hips, legs, and lower back
• Muscle weakness, especially in the thighs and shoulders
• A waddling walk or difficulty climbing stairs
• Bones that break after only a minor bump or fall
• Feeling generally tired and stiff

Symptoms in children

• In children, this condition is called rickets, not osteomalacia.
• Symptoms include bowed legs, thickened ankles or wrists, delayed growth, and bone pain.
• Children may also have weak muscles and be late to begin walking.

Symptoms in older adults

• Bone pain that is often mistaken for ageing or arthritis
• Weak legs and a higher risk of falls
• A dull ache in the lower back, hips, or legs that gets worse with movement
• Fractures from a simple fall

Causes

Main causes

• Too little vitamin D from sunlight exposure
• Not eating enough vitamin D, calcium, or phosphate-rich foods
• Digestive problems that prevent nutrients being absorbed, such as coeliac disease, Crohn's disease, or after weight-loss surgery
• Kidney or liver disorders that stop vitamin D from being used properly
• Certain medicines used to treat epilepsy, which can interfere with vitamin D metabolism

Risk factors

• Living in a place with long winters or little sunlight
• Keeping your skin covered most of the time
• Having darker skin – higher levels of melanin reduce the skin's ability to make vitamin D from the sun
• Being housebound or living in a care home
• Following a very limited diet, such as a strict vegan diet without vitamin D supplements
• Having a health condition that affects fat absorption, such as cystic fibrosis or liver disease
• Being pregnant or breastfeeding, because the body needs extra calcium and vitamin D

When to see a doctor

See a doctor urgently if:

• If you have severe bone pain or a suspected fracture, especially after a fall, seek care the same way you would for an urgent injury.
• If you have muscle spasms or tingling in your face or hands, get medical help quickly – this could mean calcium levels are dangerously low.

Book a routine appointment if:

• Make an appointment if you have ongoing bone pain, muscle weakness in your thighs or hips, or repeated falls.
• If you have a digestive or kidney condition and you are worried about bone health, ask your doctor for a bone check.
• If you are housebound or over 65 and have not been outdoors much recently, mention this to your doctor.

Diagnosis

Your doctor will ask about your symptoms, lifestyle, diet, and any medicines you take. They will also check your muscles and bones for tenderness and weakness. There is no single 'one-part' test – a diagnosis is made by combining your history, a physical exam, and test results.

Tests that may be done

• Blood tests to check levels of vitamin D, calcium, phosphate, and alkaline phosphatase – a substance that rises when bones are soft
• Urine tests to see how your body is handling calcium and phosphate
• X-rays or a bone density scan (DXA) to look for weak or thin bones
• Sometimes a bone biopsy – a small sample of bone taken under local anaesthetic – but this is rarely needed

What to expect at your appointment

Your doctor may refer you to a specialist such as a rheumatologist (joint and bone specialist) or an endocrinologist (hormone specialist). You might need a few tests before the diagnosis is clear. This is normal, and it does not mean your condition is serious.

Treatment

Treatment aims to put the missing minerals back into your bones and to treat any cause that led to the deficiency. Most people feel better within a few weeks to months, although full bone healing can take a year or more.

Self-care at home

• Get some safe sunlight exposure – a few minutes on uncovered skin most days, but the exact amount depends on your skin type and location. Ask your doctor for personal advice.
• Eat foods rich in vitamin D and calcium, such as oily fish, eggs, fortified dairy or plant milks, and leafy green vegetables.
• If you are a smoker or drink heavily, ask your doctor for support to quit – both affect calcium and vitamin D levels.
• Once your bones start to heal, try gentle weight-bearing exercise such as walking or yoga – but follow your doctor's advice first. If you have severe bone pain, wait until you are safe to exercise.

Medical treatments

Your doctor may recommend vitamin D and calcium supplements. The type, dose, and how long you need them will be decided based on your blood tests and the cause of your deficiency. If an underlying condition like coeliac disease or kidney disease is present, that will be treated too. Do not take extra supplements without your doctor's advice, because too much can be harmful.

When is surgery considered?

Surgery is rarely needed for osteomalacia itself. If a bone has broken badly – for example, a hip fracture – you may need surgery to repair the break, but the main treatment for osteomalacia is still correcting the deficiency with supplements and lifestyle changes.

Living with this condition

For the first few months, you may still feel bone tenderness and muscle weakness while your body restores its mineral levels. Be patient and gentle with yourself. Keep up with follow-up appointments and blood tests so your doctor can adjust your treatment as you improve.

Lifestyle tips

• Prevent falls at home: remove loose rugs, improve lighting, install grab bars near stairs and the toilet, and wear non-slip shoes.
• Let family members know what you are experiencing and how they can help.
• If you are housebound, ask your clinic about home visits for blood tests or telephone consultations.
• If your vitamin D is very low, avoid vigorous exercise or heavy lifting until your doctor gives you the green light.

Diet and exercise

Aim for vitamin D and calcium-rich foods every day. For exercise, start gently: seated exercises, gentle stretching, or walking on flat ground can help rebuild muscle strength and balance once pain improves. A physiotherapist can design a safe plan for you.

Mental health and emotional wellbeing

Living with ongoing pain and weakness can feel frustrating and can sometimes lead to low mood or anxiety. These feelings are normal. Talk to your doctor if you notice sadness, worry, or trouble sleeping – they can offer support and point you to counselling or peer support groups.

Prevention

Yes, in most cases osteomalacia can be prevented. The best steps are getting safe sun exposure, eating a balanced diet with enough vitamin D and calcium, and taking supplements if your doctor advises them – especially if you are at higher risk.

Vaccines

Vaccines do not prevent or treat osteomalacia.

Screening programmes

There is no routine screening for everyone. However, if you are at risk – for example, if you are housebound, over 65, or have a condition that affects absorption – your doctor may recommend a blood test to check your vitamin D level.

Complications

If left untreated

• Bone fractures that happen easily, even with a minor bump or fall
• Severe bone pain and weakness that make it hard to walk or climb stairs
• Bone deformities, such as bowing of the legs
• Muscle weakness that increases the risk of repeated falls and broken bones
• Low levels of calcium in the blood, which can cause dangerous muscle spasms, tingling, or, rarely, heart rhythm problems

Long-term outlook

With proper treatment, the vast majority of people get much better. Bone pain often eases within weeks or months, and over a period of a year or more, bones regain much of their strength. The key is to follow your care plan, stay in touch with your doctor, and give your body the time it needs to heal.

Find support

International organisations

• International Osteoporosis Foundation ↗

Local organisations

• NHS – UK National Health Service ↗ · United Kingdom

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.