Osteomalacia

Definition
Osteomalacia refers to a softening of your bones, often caused by a vitamin D deficiency.
Soft bones are more likely to bow and fracture than are harder, healthy bones.
Osteomalacia is not the same as osteoporosis, another bone disorder that also can lead to bone
fractures. Osteomalacia results from a defect in the bone-building process, while osteoporosis
develops due to a weakening of previously constructed bone.
Muscle weakness and achy bone pain are the major symptoms of osteomalacia. Treatment for
osteomalacia involves replenishing low levels of vitamin D and calcium and treating any
underlying disorders that may be causing the deficiencies.
Symptoms
In the early stages, you may have no osteomalacia symptoms, although signs of osteomalacia
may be apparent on X-ray pictures or other diagnostic tests. As osteomalacia worsens, you
may experience 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 may be worse at night, or when you're putting weight on
affected bones.
Decreased muscle tone and leg weakness may cause a waddling gait and make it difficult for
you to get around.
Causes
Your body uses calcium and phosphate to build strong bones. Osteomalacia may occur if you
don't get enough of these minerals in your diet or if your body doesn't absorb them properly.
These problems may be caused by:
 Vitamin D deficiency. Sunlight produces vitamin D in your skin. Your body needs
vitamin D to process calcium. Osteomalacia can develop in people who spend little
time in sunlight, wear very strong sunscreen or remain covered while outside.
 People who live in areas where sunlight hours are short or eat a diet low in vitamin D
can develop osteomalacia. Vitamin D deficiency is a common cause of osteomalacia
worldwide.
 Certain surgeries. Normally, the stomach breaks down food to release vitamin D 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 (gastrectomy), and may result in
osteomalacia. Surgery to remove or bypass your small intestine also can lead to
osteomalacia.
 Celiac disease. In this autoimmune disorder, the lining of your small intestine is
damaged by consuming foods containing gluten, a protein found in wheat, barley and
rye. A damaged intestinal lining doesn't absorb nutrients, such as vitamin D, as well
as a healthy one does.
 Kidney or liver disorders. Problems with your kidneys or liver can interfere with
your ability to process vitamin D.
  Drugs. Some drugs used to treat seizures, including phenytoin (Dilantin, Phenytek)
and phenobarbital, can cause osteomalacia.
Risk factors
The risk of developing osteomalacia is highest in people who have both inadequate dietary
intake of vitamin D and little exposure to sunlight, such as older adults and those who are
housebound or hospitalized.
Complications
If you have osteomalacia, you're more likely to experience broken bones, particularly in your
ribs, spine and legs.
Tests and diagnosis
In order to pinpoint the underlying cause of osteomalacia and to rule out other bone disorders,
such as osteoporosis, you may undergo one or more of the following tests:

 Blood and urine tests. In cases of osteomalacia caused by vitamin D deficiency or by

phosphorus loss, abnormal levels of vitamin D and the minerals calcium and phosphorus
are often detected.
 X-ray. Slight cracks in your bones that are visible on X-rays — called Looser
transformation zones — are a characteristic feature of people with osteomalacia.
 Bone biopsy. During a bone biopsy, your doctor inserts a slender needle through your
skin and into your bone to withdraw a small sample for viewing under a microscope. This
procedure is done after using a local anesthetic and takes only about a half-hour.
Although a bone biopsy is very accurate in detecting osteomalacia, it's not often needed to
make the diagnosis.

Treatments and drugs

When osteomalacia arises from a dietary or sunlight deficiency, replenishing low levels of
vitamin D in your body usually cures the condition.
Generally, people with osteomalacia take vitamin D supplements by mouth for a period of
several weeks to several months.
If your blood levels of calcium or phosphorus are low, you may take supplements of those
minerals as well. In addition, treating any condition affecting vitamin D metabolism, such as
kidney disease or low phosphate levels, often helps improve the signs and symptoms of
osteomalacia.
Prevention
Osteomalacia caused by inadequate sun exposure or a diet low in vitamin D often can be
prevented. Here are a few suggestions to help reduce your risk of developing osteomalacia:

 Eat foods high in vitamin D. These include foods that are naturally rich in vitamin
D, such as oily fish (salmon, mackerel, sardines) and egg yolks. Also look for foods that
are 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 affecting the ability of your digestive system to
absorb nutrients properly, ask your doctor about taking a vitamin D supplement and a
calcium supplement.

Although a lack of sun exposure is linked to the development of osteomalacia, spending time
in the sun can't currently be recommended for prevention or treatment. That's because it's not
clear how much sun you would need to prevent or treat osteomalacia, and because
unprotected sun exposure can increase your risk of skin cancer. There's currently no
consensus among experts about what amount of sun exposure is safe.