Osteomalacia

What is osteomalacia?

Osteomalacia is also known as ‘soft bones’. It causes bone pain, soft or weak bones and poor growth.

What are the symptoms of osteomalacia?

Oftentimes, osteomalacia does not cause any symptoms. But if it becomes more advanced then the most common symptoms in adults are:

• Fragile bones that break or fracture easily

• Tiredness

• Bone pain in the rib, hip, pelvis, thigh and foot

• Stiffness

• Finding it hard to walk upstairs or get up from sitting

• Muscle weakness or cramps in your thighs and arms

• Walking with a side-to-side stride

What causes osteomalacia?

The most common cause of osteomalacia in adults is a lack of vitamin D. Vitamin D is essential for the health of your bones. It controls how much calcium and phosphorus are used to form your bone's hard surface.

In the winter, over a third of the adult population in the UK does not have enough vitamin D in their body. Vitamin D deficiency usually happens when you don’t get enough vitamin D – adults need at least 10 micrograms every day. You can get vitamin D from sunlight, supplements, or certain foods. 

Some people also have trouble absorbing vitamin D. Your body’s ability to absorb and use vitamin D can be affected by:

• Surgery that removes part of your intestines or stomach, like a gastric bypass which can result in intestinal malabsorption

• Coeliac disease

• Liver disorders like cirrhosis

• Chronic kidney disease

• Seizure medications, like phenytoin, carbamazepine and phenobarbital

How common is osteomalacia?

It’s thought that at least a quarter of people throughout Europe have osteomalacia. Some of the most common risk factors include:

• Wearing full-coverage clothing often

• Having darker skin

• Low exposure to the sun

• Having an unbalanced diet

How is osteomalacia diagnosed?

Some tests your GP might recommend to diagnose osteomalacia include:

• Blood tests – to check the level of vitamin D in your body

• Imaging – such as a bone density scan (DEXA scan) to check the amount of phosphate and calcium in your bones

• A bone biopsy – where a piece of bone tissue from your pelvic bone will be removed with a needle under general anaesthetic and tested for signs of vitamin D deficiency

How is osteomalacia treated?

Vitamin D supplements are the most common form of treatment for osteomalacia and will usually cure the condition after several months. But these will need to be taken regularly to prevent the disease from coming back.

You can also increase your vitamin D intake in the following ways:

Sunlight

Most people can get all the vitamin D they need from a short daily sunlight exposure on their skin from late March or early April to the end of September (especially between 11 am and 3 pm when the sun is at its strongest). Be careful not to expose your skin too much as this is unlikely to provide extra vitamin D and you can burn.

Sunbeds do not provide a source of vitamin D and are harmful to your skin.

Diet

From October to early March, a lack of strong sunlight means that your body can’t make enough vitamin D from the sun. However, during these months, you can increase your vitamin D intake from food sources, including:

• Fortified breakfast cereals

• Dairy products like cheese, milk or yoghurt

• Eggs

• Fish like salmon, tuna, salmon, sardines or swordfish

• Liver

• Fortified orange juice 

Orthopaedic treatment and surgery

If osteomalacia has caused your bones to break or become deformed, a GP may give you an orthopaedic brace to wear to correct the problem.

In some cases, if your osteomalacia is severe, then you may require surgery.

Are there any complications of osteomalacia?

If osteomalacia is left untreated, you’ll be at a higher risk of broken bones. One type of fracture, called an insufficiency fracture, can happen without much trauma. These areas are particularly at risk of fractures:

• Hips

• Ribs

• Shoulder blades

• Collarbones

How long does osteomalacia last?

Depending on the cause, recovering from osteomalacia can take anywhere from several months to a year. 

When should I speak to a doctor?

If you’re experiencing any of the symptoms of osteomalacia, like bone pain, weakness, or stiffness, book an appointment to speak to a doctor.

How can Livi help?

A Livi doctor will ask you questions about your symptoms. They’ll make an individual assessment, recommend a treatment or refer you to a specialist if needed.