Osteomalacia

Osteomalacia is the medical term for the softening of the bones. This condition happens when your body doesn’t have enough vitamin D, calcium, or phosphate to keep bones strong. Without these nutrients, bones lose their hardness and become weak, making them more likely to bend or break. In children, the same condition is called rickets.

While it may look similar to osteoporosis, the key difference in osteomalacia vs. osteoporosis lies in the cause. Osteoporosis involves bone thinning, while osteomalacia is a problem with bone mineralization, or how the bone hardens in the first place.

Penn Medicine offers a team-based approach to osteomalacia to provide effective treatment as well as education and support for maintaining lifelong bone health.

Symptoms of osteomalacia may develop slowly and can be mistaken for other conditions. Common signs include:

• Dull, aching pain in the hips, lower back, legs, or ribs
• Muscle weakness, especially in the thighs or shoulders
• Bone fractures with little or no injury
• Difficulty walking or a waddling gait

When calcium levels are also low, people may notice:

• Tingling or numbness around the mouth
• Muscle cramps or spasms in the hands and feet
• Numbness or tingling in the arms or legs

Because osteomalacia symptoms may take years to appear, regular checkups and bone health screenings are important for early detection.

Osteomalacia most often develops when the body does not get enough vitamin D. Vitamin D helps your body absorb calcium from food, and without it, bones cannot harden properly. Lack of sufficient vitamin D may be due to:

• Limited sun exposure because of your climate, an indoor lifestyle, your amount of clothing coverage, or heavy sunscreen use
• Darker skin pigmentation
• Low vitamin D or calcium intake, often related to vegetarian diets or lactose intolerance
• Conditions that reduce absorption of nutrients, such as celiac disease, Crohn’s disease, or weight-loss surgery
• Liver or kidney disease, which prevents the body from processing vitamin D normally
• Rare tumors or certain medications (such as seizure drugs) that affect vitamin D or phosphate levels

Osteomalacia is mainly treated by correcting vitamin D deficiency and, when needed, adding calcium or phosphorus supplements. Most patients take vitamin D by mouth, spend more time in sunlight, and eat calcium-rich foods.

In some cases, treatment also includes adjusting medications that weaken bones, managing underlying conditions such as kidney or liver disease, or using physical therapy to improve strength and mobility. People with absorption problems may need special forms of vitamin D, such as calcitriol (the active form of the vitamin), along with regular medical follow-up.

Symptoms often improve within weeks, but full bone healing can take several months.

Osteomalacia can often be prevented by getting enough vitamin D and calcium through diet, supplements, and safe sunlight exposure. Foods rich in vitamin D, like oily fish and fortified dairy, support healthy bones. People at higher risk—such as older adults, those with absorption problems or darker skin, or anyone with limited sun exposure—may need extra supplements and guidance from their doctor.

Choosing Penn Medicine gives you access to experts who understand the complexities of osteomalacia and other bone disorders. Our teams come together from many disciplines to uncover the root cause of osteomalacia and create a personalized treatment plan. Specialists at the Penn Bone Center evaluate and treat patients with low bone mineral density, softening of the bones, and related conditions that increase fracture risk.

Osteomalacia care at Penn Medicine brings together:

• Endocrinologists for hormone and vitamin D metabolism
• Nephrologists and gastroenterologists for kidney- and absorption-related causes
• Orthopaedic surgeons for fractures and bone repair
• Radiologists and pathologists for advanced imaging and diagnostic testing
• Nutrition and physical therapy specialists for long-term bone health and recovery