Osteomalacia is a painful softening of the bones. It is usually caused by a lack of vitamin D or calcium.


What is osteomalacia?

Osteomalacia is the softening of the bones in the human body, often caused by a lack of vitamin D. In children, these symptoms are also known as rickets.

Soft bones affected by osteomalacia are more likely to be injured or fractured than harder and healthier bones. Osteomalacia is not to be confused with osteoporosis, another disorder that can also lead to bone injury. Osteomalacia results from a defect in the bone formation process, while osteoporosis refers to a weakening of the already developed bone structure. See theinternetfaqs for Idiopathic Juvenile Osteoporosis Basics.

Muscle and bone pain are the most common signs and symptoms of osteomalacia. Treatment of osteomalacia includes correction of predominant calcium and vitamin D deficiencies; and the targeted healing of any underlying disease associated with the development of osteomalacia.


The human body uses calcium and phosphates to build strong bones. Osteomalacia is usually caused by a lack of these nutrients in the diet. The same applies if the body cannot process the substances sufficiently.

Vitamin D is made by the body when sunlight hits the skin. Vitamin D is needed to process calcium. For example, osteomalacia can occur in people who spend little or no time in the sun, or who live in areas where sunshine hours are short or the air is heavily polluted.

Osteomalacia can also result from certain operations on the stomach (gastrectomy). Because the absorption of vitamin D from food is reduced. Celiac disease, liver or kidney damage can also lead to osteomalacia as they disrupt essential body processes.

Symptoms, Ailments & Signs

Initially, osteomalacia manifests itself as muscle weakness and non-specific bone and joint pain. As the disease progresses, the characteristic hump develops. The increasing curvature of the upper body is associated with chronic pain and restricted mobility. The visual changes can also cause psychological problems.

Once a hump has formed, it can usually no longer be corrected, which is why the misalignment is a constant burden for those affected. As a result of the reduced bone density, there is also an increased susceptibility to fractures. The femoral neck and vertebral bones are particularly affected. If the symptoms are caused by malnutrition, symptoms such as weakness, tiredness and difficulty concentrating can appear.

In addition, those affected are often emaciated and have a sickly appearance. If the cause of osteomalacia is treated early, the symptoms described usually subside. Most patients are symptom-free no later than one to two months after the start of treatment. If left untreated, bone softening leads to further fractures and deformities.

In the long term, this leads to stiffness, chronic pain and ultimately bedriddenness. If left untreated, the disease will take a severe course, which is associated with other symptoms and complaints. External signs, such as the hunchback described, also become stronger as the disease progresses.

Diagnosis & History

In order to identify the cause of osteomalacia and rule out possible other diseases, the patient may need to undergo the following tests. Blood and urine tests: If osteomalacia is caused by vitamin D deficiency or phosphate depletion, these abnormal levels may be detected in the blood or urine.

X-ray examination: Osteomalacia leads to characteristic injuries in the bone structures that can be seen on x-rays.

Bone biopsy: During a bone biopsy, the doctor inserts a thin needle through the skin into the bone. A small sample of the bone is taken to be examined under a microscope. Although biopsy is very accurate for identifying osteomalacia, it is rarely used.


Osteomalacia is a disease that can be prevented with an adequate supply of vitamin D in the body. If the disease is present, serious complications can only be avoided with the help of intensive treatment. If left untreated, a so-called creeping pathological fracture usually develops.

However, since the bones are softer here, the fractures do not occur suddenly, but gradually. They are thus expressed in increasing curvatures in places where increased bending stresses are present. This is how the upper body bends. The neck of the femur is also subject to particular bending stresses, so that fractures of the upper neck can often occur in the case of osteomalacia. This is particularly the case with older people, since they have increased osteoporosis in addition to softening of the bones due to the often severe undersupply of vitamin D.

Femoral neck fractures usually cause severe pain to the patient and limit mobility. The healing process usually progresses very slowly. In the conservative treatment of a femoral neck fracture, there is an increased risk of venous thrombosis and pulmonary embolism. Due to this fact, osteomalacia can also lead to death more frequently in older people. For this very reason, it is important to ensure that older people have an adequate supply of vitamin D.

When should you go to the doctor?

A reduction in general physical exercise capacity or restrictions in mobility should be presented to a doctor. If there are general problems with the musculoskeletal system or an abnormal posture, it is advisable to see a doctor. A crooked posture is characteristic of patients with osteomalacia. In addition, those affected suffer from pain. You should generally refrain from taking painkillers until you have consulted a doctor. Side effects can occur that lead to further deterioration of health. Concentration disorders, exhaustion or fatigue should be discussed with a doctor.

If the existing symptoms increase in scope or intensity, a doctor should be consulted immediately. A decrease in the quality of life or a reduction in well-being should be clarified by a doctor. If the everyday obligations or sporting activities can no longer be carried out in the usual form, the person concerned needs help. Stiffening of the muscular system, inner weakness as well as exhaustion and fatigue are signs of a disease that requires treatment. If the irregularities last for several days or weeks, a doctor is needed.

If left untreated, it can lead to serious health problems and other visual changes in the bone structure. If you also have mental or emotional problems, you should also consult a doctor. Social withdrawal, tearfulness, or personality changes should be discussed with a doctor.

Treatment & Therapy

When osteomalacia is caused by malnutrition or lack of sun exposure, this deficiency can be treated with a simple supplement of vitamin D.

Affected patients usually take vitamin D supplements by mouth. Over a period of a few weeks or months. Less common is direct injection of vitamin D through a vein in the arm. If the levels of calcium and phosphorus are also low, therapy with preparations may also be prescribed here. In addition, treating an underlying condition such as kidney failure or primary biliary cirrhosis also improves the symptoms of osteomalacia.

Those affected are usually advised to seek out more sunlight. Care should be taken to expose oneself to several shorter units (15 minutes a day) of sunlight than longer, irregular units (risk of sunburn).

In advanced cases, sufferers may need to use orthotics to support weak bones or surgery to correct deformed bones. With successful treatment, the effects and symptoms of osteomalacia can be completely cured, sometimes in just a few months.

Outlook & Forecast

In general, osteomalacia is a highly treatable and curable disease, although its outcome depends greatly on when the disease is diagnosed. The earlier the beginning softening of bones or certain deficiencies are diagnosed and corrected through optimal therapy, the less the effects of demineralization and the better the prognosis.

Adequate drug treatment – ​​taking high doses of vitamin D and calcium – usually achieves healing in four to six months. Skeletal changes can often be reversed in this way. In small children, existing bone deformities often correct themselves spontaneously. Nevertheless, permanent deformation of the bones may be possible in some sufferers. In such cases, as well as in the case of very severely deformed bones – in the case of too late diagnosis – surgical or orthopedic interventions must be carried out.

However, for all those affected, older people, vegetarians and people with dark complexion (who can enjoy less sunlight due to emigration to more northerly areas), it is still important to ensure an adequate intake of vitamin D and calcium. In addition, a vitamin-rich food supply (fish, cod liver oil, egg yolk, milk, milk products) and sufficient exposure to the sun should be taken to heart. Thanks to routine prophylaxis in infancy, rickets and osteomalacia are now rare in Europe. For prevention, the daily supply of vitamin D drops over the first three years of life is therefore of immense importance.


Since the direct causes of osteomalacia can be clearly identified, everyone can make a good contribution to prevention. Direct exposure to sunlight should be sought regularly. 15 minutes a day is enough. When it comes to nutrition, care should be taken to include foods with a high vitamin D content. These include: oily fish like salmon and sardines; Grain products such as bread or dairy products such as yoghurt are also rich in vitamin D.


In most cases, those affected with osteomalacia only have limited follow-up measures available. For this reason, the person concerned should consult a doctor at an early stage in order to prevent the occurrence of further complications. At worst, the disease can cause bone fractures if not treated properly.

Those affected are usually dependent on taking various medications and preparations, which can alleviate and limit the symptoms. The doctor’s instructions must always be followed, and the doctor must always be contacted first if you have any questions or if anything is unclear. Furthermore, direct exposure to the sun should also be avoided so as not to provoke the symptoms.

During the treatment, regular checks and examinations of the affected person are necessary, whereby the internal organs and especially the kidneys should be checked regularly. In severe cases of osteomalacia, a kidney transplant is necessary, which usually reduces the life expectancy of the person affected. However, the further course depends very much on the severity of the disease and also on the time of diagnosis, so that a general prediction is usually not possible.

You can do that yourself

In the case of osteomalacia, measures must first and foremost be taken to compensate for the underlying vitamin D and calcium deficiency. Patients must change their diet and consume foods with sufficient vitamins and minerals. Bananas, nuts, legumes, fish, cheese, eggs and mushrooms, for example, have proven themselves. At the same time, unhealthy food and drinks such as fast food and alcohol should be avoided.

In addition, osteomalacia patients should take it easy. Too much physical activity can lead to injuries and fractures that are slow to heal due to underlying bone softening. Sporting activities should only take place in consultation with the orthopaedist. Physiotherapy is recommended, which can be supplemented at home with simple gymnastic exercises. With osteomalacia, bone health continues to deteriorate, which is why the affected person should use a walker at an early stage.

Since the suffering and the associated limitations can sometimes also affect the psyche, patients should seek therapy. Talking to friends and other people affected can help. The doctor can establish contact with self-help groups and, if necessary, give tips for further self-help measures.