By Kimberly Charleson 

 Medically reviewed by Anita C. Chandrasekaran, MD

Osteomalacia and osteoporosis are both bone conditions that affect the bones in different ways. Osteomalacia causes soft bones due to a lack of vitamin D. It is a disorder of decreased mineralization, which results in bone breaking down faster than it can re-form. In osteoporosis, bone mass decreases over time, leading to weakened and brittle bones that are susceptible to fracture.

This article discusses the different symptoms, causes, and treatments for osteomalacia and osteoporosis.

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Symptoms

Both osteomalacia and osteoporosis involve a deterioration of the bone and often lead to fractures.

Osteoporosis does not cause any symptoms, so it can go undetected and is largely referred to as a "silent" disease.1 Most people aren't aware they have it until after they experience a broken bone or fracture.

However, you can watch out for the following possible symptoms that could signal osteoporosis:

• Loss of height (getting shorter by an inch or more)

• Change in posture (stooping or bending forward)

• Shortness of breath (smaller lung capacity due to compressed disks)

• Pain in the lower back

The most common symptoms of osteomalacia are:2

• Pain in the bones and hips

• Muscle weakness

• Difficulty walking

Showing Symptoms

Osteomalacia shows symptoms, while osteoporosis is called the silent disease because it doesn't cause symptoms.

Causes

Osteomalacia

The most common cause of osteomalacia is a severe vitamin D deficiency. Bones aren't able to properly mature from a lack of vitamin D, which is essential for calcium absorption and maintaining bone health.2 This leads to pseudofractures in the body and subsequent symptoms like pain.

Vitamin D is usually the result of a lack of sunlight or, less frequently, a digestive disease or kidney disease.3

Osteoporosis

It's not clear what exactly causes osteoporosis, but certain factors increase your risk of developing the condition. As you age, your bones weaken and have to depend on the strength of the bones you created earlier in your life.

The inside of healthy bone looks like a sponge. This area is called trabecular bone. An outer shell of dense bone wraps around the spongy bone. This hard shell is called cortical bone. When osteoporosis occurs, the holes in the sponge grow larger and more numerous, which weakens the inside of the bone.1

When the body needs calcium, it breaks down and rebuilds bone. This process is called bone remodeling. Up until about age 30, you normally build more bone than you lose. After age 35, bone breakdown occurs faster than bone buildup, which causes a gradual loss of bone mass. With osteoporosis, you lose bone mass at a greater rate.1

Bone mass is typically dependent on genetics, ethnicity, and sex. Women with estrogen deficiencies are more likely to have increased bone loss, which leads to decreased bone density and osteoporosis.4

To stay healthy, bones require activity as much as other parts of the body. Living an inactive lifestyle, especially over time, contributes to bone loss, which directly causes osteoporosis.

Some medical conditions and medications can also increase your risk of developing osteoporosis, including:1

• Overactive thyroid, parathyroid, or adrenal glands

• History of weight loss surgery or organ transplant

• Hormone treatment for breast or prostate cancer or a history of missed periods

• Celiac disease or inflammatory bowel disease (IBD)

• Blood diseases such as multiple myeloma

• Chronic steroid use (prednisone)

Diagnosis

Osteomalacia

To properly diagnose osteomalacia, blood and urine tests are done to check vitamin D, calcium, and phosphorus levels.

X-rays are also performed to look for structural changes or cracks in bones.

Your healthcare provider may order a bone biopsy, in which a needle is inserted into the pelvic bone to take a sample of bone for analysis in a lab. It is an accurate way to detect osteomalacia, but it isn't used often.

Osteoporosis

A bone density test is the only test that can diagnose osteoporosis before a broken bone occurs. Bone density tests are recommended for:5

• Women over the age of 65

• Men over the age of 70

• Women under the age of 65 and men between the ages of 50 and 69 if risk factors are present

A bone density test, known as dual-energy X-ray absorptiometry (DEXA) scan, is performed to evaluate decreases in bone density and the risk for broken bones, as well as to monitor treatment progress.5 These X-rays use very small amounts of radiation to determine how solid the bones of the spine, hip, or wrist are.

Predetermined standards for bone density give providers a range to categorize each person. Unfortunately, most people don't seek a diagnosis until they have a fracture because osteoporosis doesn't cause any symptoms.6

Diagnosing Osteomalacia and Osteoporosis

Diagnosis requires tests and imaging to differentiate osteomalacia and osteoporosis from other conditions. Symptomatic osteomalacia and fractures as a result of osteoporosis can appear similar. A bone density test is the gold standard for diagnosing osteoporosis, while blood testing measuring vitamin D levels is the best way to diagnose osteomalacia.

Treatment

Osteomalacia

Osteomalacia can be caught early and cured. Depending on the severity of osteomalacia, taking vitamin D supplements over several weeks can improve the condition.

Vitamin D is the main, but not sole, contributor to this condition. Healthcare providers may also recommend calcium and phosphorus supplements in addition to vitamin D supplements.

If there is an underlying cause of vitamin and mineral deficiencies like kidney disease, getting treatment for it can treat osteomalacia as well.

Osteoporosis

Osteoporosis treatment depends on the results of the bone density test, age, and other risk factors. If a bone density scan shows a high risk of fracture, medications are recommended.

Determining the underlying cause can also help your healthcare provider determine the best treatment for you. Unlike osteomalacia, osteoporosis can have several other contributing factors, like hormone levels.

The goal of treatment is to manage your symptoms and avoid fractures. Medications and lifestyle changes are components of a typical treatment plan for osteoporosis. Medications aim to strengthen bones and increase vitamins and minerals in the body. Exercise is a helpful lifestyle change that can promote bone growth and strength.

Osteoporosis is commonly treated with drugs called bisphosphonates. These drugs help prevent further bone loss, slowing the disease and avoiding fractures.

Types of bisphosphonates include:

• Fosamax (alendronate)

• Boniva (ibandronate)

• Actonel (risedronate)

If there is a concern with testosterone or estrogen production leading to low bone density, hormone therapy can be used.

Treatment Recap

Treatment options depend on the diagnosis and severity. While osteomalacia can be cured after only a few weeks of supplements, osteoporosis treatment focuses on managing symptoms. Providers prescribe medications for osteoporosis but not osteomalacia.

Prevention

Prevention for both conditions starts with a proper intake of vitamins and minerals. With adequate levels of vitamin D and calcium, osteomalacia can be prevented.

Similarly, osteoporosis can be prevented by boosting your bone health. This is done by eating a diet high in vitamin D and minerals, taking supplements, and exercising regularly.

While preventive measures make the biggest difference when taken early in life, these habits should continue throughout life to keep bones as strong as possible.

Summary

Osteomalacia and osteoporosis appear similar, but have different symptoms, causes, and treatment. It is critical for you to get the most accurate diagnosis to create a successful treatment plan. While osteoporosis isn't curable, there are ways to support bone growth and strength.

Sources

Cleveland Clinic. Osteoporosis.

Cleveland Clinic. Osteomalacia.

National Kidney Foundation. Mineral and Bone Disorder.

1.Marcus and Feldman’s Osteoporosis. Estrogen deficiency and the pathogenesis of osteoporosis. Marcus and Feldman’s Osteoporosis. Elsevier; 2021:773-797. doi:10.1016/B978-0-12-813073-5.00032-0.

2.National Osteoporosis Foundation. Bone density exam/testing.

3.Sözen T, Özışık L, Başaran NÇ. An overview and management of osteoporosis. Eur J Rheumatol. 2017;4(1):46-56. doi:10.5152/eurjrheum.2016.048

By Kimberly Charleson
Kimberly is a health and wellness content writer crafting well-researched content that answers your health questions.