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Osteomalacia and Rickets

A disease of adults, osteomalacia is characterized by soft bones due to a failure of bone to absorb calcium. The disorder is caused by various factors including too little vitamin D in the diet, insufficient exposure to sunlight, and malabsorption of vitamin D in the intestine due to conditions such as celiac disease or after gastrointestinal surgery. Osteomalacia can lead to pain in the legs, ribs, hips, and muscles, and to easily broken bones and impaired mobility.

In children, the same condition is known as rickets and is usually caused by a vitamin D deficiency. Babies who are breast fed for more than a year (with no vitamin D supplements) and children deprived of sufficient sunlight are most at risk of developing rickets.

However, the incidence of rickets has been significantly reduced in North America, where most milk and other dairy foods are now fortified with vitamin D.

Risk factors for osteomalacia are related to the causes. In the elderly, there is an increased risk among people who tend to remain indoors and those who avoid milk because of lactose intolerance.

Symptoms

• Diffuse bone pain, especially in the hips
• Muscle weakness
• Bone fractures with minimal trauma

Signs and tests

• A bone biopsy shows osteomalacia.
• Serum vitamin D level may be low.
• Serum calcium levels vary with the cause of the disorder.
• Serum phosphate levels vary with the cause of the disorder.
• A bone X-ray may show features of osteomalacia.
• A bone mineral density scan (DEXA) may show reduced bone mineral density.
• Other tests may be done to determine renal problems or other underlying disorders.

Treatment

Oral supplements of vitamin D, calcium and phosphorus may be given depending on the underlying cause of the disorder. Larger doses of vitamin D and calcium may be needed for people with intestinal malabsorption.

Monitoring of blood levels of phosphorus and calcium may be indicated for people with certain underlying conditions.

Improvement in the condition of the bones, evidenced by bone X-rays, can be seen within a few weeks in some people with vitamin deficiency disorders. Complete healing with treatment takes place in 6 months.

Source: Nutrition for Life - Lisa Hark, PhD, RD & Darwin Deen. MD; Healthline Web site

Adapted by Editorial Staff, May 2007. Last update, August 2008