Vitamin D and Osteomalacia
Vitamin D and Osteomalacia
Vitamin D and Ostemalacia are inextricably linked. Osteomalacia is one of the major bone diseases that affects adults who have Vitamin D deficiency.
Osteomalacia - soft bones
This is a VERY serious, debilitating disease so please read on.
What is Osteomalacia?
Osteomalacia means “soft bones”- osteo meaning “bone” and malacia meaning “softness”. Softening of the bones is caused by a lack of Vitamin D or a problem with the body’s ability to break down and use this vitamin.
Bones need calcium and phosphorus to remain healthy and strong, but the body also needs Vitamin D to absorb these two minerals. Without this necessary vitamin, bones can become soft and flexible. This softening is called osteomalacia in adults and rickets when diagnosed in children.
Is there a difference between Osteomalacia and Osteoporosis?
Yes. Although both are bone disorders that relate to a Vitamin D deficiency and result in bone fractures, osteomalacia is caused by a defect in the bone-building process, whereas osteoporosis develops due to a weakening of previously normally-constructed bone.
Let’s look at how bones develop
Throughout life your bones are continually maintaining and repairing themselves. This process is called “bone turnover”. Turnover occurs when tiny areas of bone are removed and replaced, swapping old bone for new bone.
Bone strength depends on the amount of minerals that are laid down in them during a process called “mineralisation”. Minerals such as calcium and phosphorus are taken from the food you eat and deposited in your bones. Vitamin D is an important component of this process helping the body to absorb calcium and makes sure it gets to the right location. During childhood, mineralisation ensures that bones grow and develop, whereas in adulthood it maintains and repairs them.
Osteomalacia and bone development
Osteomalacia occurs when your bones don’t get enough of the minerals they need. This makes them soft and weak, and can cause them to crack or break more easily. It can also cause bone deformities.
The causes of Osteomalacia
Osteomalacia is caused by prolonged low levels of Vitamin D in the body. Vitamin D deficiency can occur because of:
- lack of Vitamin D in the diet
- not enough exposure to sunshine due to sun cream, smog, latitude or season.
- darker skin, which requires longer sun exposure for Vitamin D production
- conditions that inhibit the body’s absorption of Vitamin D, for example intestinal disorders (including Crohn’s disease and celiac disease)
- conditions that prevent the body from producing or activating Vitamin D, such as kidney disorders and hypoparathyroidism
- certain medications, including some medications prescribed for epilepsy
Low calcium and/or low phosphorus can also be a contributing factors for the development of osteomalacia.
Who is at risk from Vitamin D deficiency?
In the UK between 10 and 30% of adults are deficient in Vitamin D, whereas in the US up to 50% of adults are deficient.
You are more likely to have low Vitamin D leading to osteomalacia if you:
Covering up can make you Vitamin D deficient
- are of Asian, African Caribbean or Middle Eastern descent – the darker your skin the less likely you are to get enough Vitamin D in temperature regions
- cover up extensively with clothing (for example, wearing a burka, scarf)
- don’t spend much time outdoors
- use too much sunscreen
- are aged 65 years and over
- have a poor diet, lacking in vitamins and nutrients, or a restrictive diet, such as vegetarian or vegan
- have avoided drinking milk for many years
Less commonly, Vitamin D deficiency can be caused by underlying conditions such as:
- conditions that affect the way the body handles Vitamin D such as those with celiac disease, Crohn’s disease, and some types of liver and kidney disease
- side-effects of some anti-epileptic medicines
Who is at risk of getting Osteomalacia?
The risk of developing osteomalacia is highest for people with very low Vitamin D levels.
- All the groups at risk of low Vitamin D levels listed above.
- Pregnant or breastfeeding women (because much of their Vitamin D goes to the baby).
- People with a family history of Vitamin D deficiency.
Signs and Symptoms of Osteomalacia
Typical signs are general bone pain, muscle pain and easy fractures of bones in the adults. Specifically:
- Widespread deep bone pain in the back, hips, ribs and long bones. This is often nagging pain in the bones which comes from the skeletal tissue. Pain is also caused by minor cracks (partial fractures) in the bones. This pain differs from arthritis pain which is the inflammation of the joints.
- Weak muscles associated with decreased mobility due to increased pain. Reduced activity leads to a reduction in muscle mass and partial or complete wasting of muscles.
- Low calcium and phosphorus levels, along with low Vitamin D levels can also affect muscle functioning.
- Decreased muscle strength of the upper arms and thighs, in particular, reduces the quality of life as well as increasing difficulty in performing simple tasks like getting up from a chair or climbing a flight of stairs.
- Bone fractures that occur during normal routine activities. Fracturing is caused by badly demineralised bones.
- Deformities of the spine. For example, lordosis which is the curvature of the spine in the lower back giving a person a “swayback” appearance. Deformities to the pelvic girdle may show as a waddling gait in the sufferer.
- Tetany – involuntary contraction (spasms) of muscles spasms and seizures caused by low levels of calcium.
In the early stages, you may have no osteomalacia symptoms, just a general feeling of being unwell, 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.
How common is Osteomalacia?
We don’t know exactly how common it is. Possibly, it is under-diagnosed, or not recognised enough in people who have symptoms such as bone pain. We know that Vitamin D deficiency in adults is very common in many countries, particularly for darker skinned individuals.
How is osteomalacia diagnosed?
Your medical history, symptoms, or lifestyle may point to osteomalacia. Blood tests can test to see if your Vitamin D levels are low and will also detect problems with the liver or bone. Usually, the symptoms plus blood tests are enough to make the diagnosis. Sometimes osteomalacia shows up on an x-ray, but x-rays are not usually necessary.
How is osteomalacia treated?
The usual treatment is to take Vitamin D supplements.
Please read if you are pregnant or breastfeeding. Supplements are extremely important to raise both your baby’s and your own Vitamin D levels. Treatment is essential to prevent the baby having low vitamin D, which could affect its growth and development. Please read our article on Vitamin D dosage to see how much Vitamin D you will need.
If you are pregnant, do not take supplements containing large amounts of vitamin A. Supplements labelled as suitable for pregnancy are safe to use. Also, do not eat liver which contains large amounts of vitamin A, as too much can harm the baby. Vitamin A can be taken if you are breastfeeding.
If you are breastfeeding and have osteomalacia with low vitamin D, your baby will need vitamin drops. Your milk will not have enough Vitamin D for a growing baby (unless you are being treated with very high doses of Vitamin D, which is not usually recommended). So, it is a good idea to discuss vitamin drops for the baby with your doctor or health visitor.
Will I recover from Osteomalacia?
If treated, the outlook is very good. Most cases of osteomalacia recover with Vitamin D treatment. However, it can take time (weeks or months) for bones to recover. So, if you have symptoms such as bone pain, this will also take time to improve. Most people who have had osteomalacia will need to take Vitamin D supplements long-term. This has many other benefits, including a reduced risk of heart disease, high blood pressure, diabetes, cancer and low moods.
With prolonged or untreated osteomalacia, the risk of getting osteoporosis (bone thinning and fractures in old age) may be increased. Additionally the risk of other diseases, such as heart disease and cancer is higher because these are also associated with Vitamin D deficiency.
How can I prevent osteomalacia?
1) Supplements. Low Vitamin D and Osteomalacia can be prevented most effectively by regularly taking supplements of Vitamin D.
For pregnant women make sure you take supplements that are labelled as suitable for use in pregnancy. Suitable supplements will be either a calcium/Vitamin D tablet, or a multivitamin tablet. Do not take supplements containing large amounts of vitamin A. Vitamin D supplements are important for your own health and to help prevent rickets in your baby.
2) Sun. Exposure your skin to direct sunshine for 15-20 minutes per day between 10 am and 3pm with hands, arms and face uncovered. People with darker skin may need longer exposure. Make sure you apply sun cream to your face and upper torso. Note that higher latitudes do not have enough sun during winter months for Vitamin D production.
3) Foods high in Vitamin D and calcium. Foods with higher levels of Vitamin D include liver, some fish (mainly oily fish such as herring, sardines, pilchards, trout, salmon, tuna and mackerel), egg yolk, and ‘fortified’ foods (which have vitamin D added) such as some margarines and breakfast cereals. Note these foods will not give you your daily requirement of Vitamin D.
Food rich in calcium include dairy products (milk, cheese, and yoghurt), beans and pulses, and green vegetables.
There is an unavoidable link between Vitamin D and Osteomalacia. Low Vitamin D levels prevent the proper absorption of calcium and phosphorus resulting in the development of soft bones. Osteomalacia is a serious, debilitating disease. However, this disease is easily treated with Vitamin D supplements. If you have low Vitamin D make sure you start taking regular Vitamin D supplements.
We recommend that you read our article on Vitamin D supplements or if you would like to contact us about finding the right supplement then click here.
Click here to find out information on Osteoporosis. You should also read the Causes of Vitamin D Deficiency, Vitamin D Deficiency Symptoms, and more information on the Sources of Vitamin D.
Heart disease is a major disease for middle age and elderly. We also recommend that you read how Vitamin D deficiency increases your risk of heart disease.
