Osteomalacia / Rickets Quiz
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Bow shaped legs
Physical activity worsens pain
Difficulty walking
Low back pain
Bone pain
Bone fracture
Hip pain
Pain in arms or legs
Limbs feel weak
Muscle pain
Whole body pain
Chest bone protruding
Not seeing your symptoms? No worries!
What is Osteomalacia / Rickets?
Osteomalacia is the softening of bones due to defective bone mineralization, often caused by vitamin D deficiency, leading to bone pain, muscle weakness, and an increased risk of fractures. Rickets is a condition characterized by weakened and deformed bones due to impaired calcium and phosphorus metabolism, primarily resulting from prolonged vitamin D deficiency.
Typical Symptoms of Osteomalacia / Rickets
- Seizure
- Previously diagnosed with a bone fracture
- Noticeable protrusion of the chest bone (Pigeon chest)
- Baby teeth haven't emerged after first birthday
- Abnormal facial sensation
- Difficulty walking normally
- Hip joint hurts when walking
- Back pain worse with exercise
Diagnostic Questions for Osteomalacia / Rickets
Your doctor may ask these questions to check for this disease:
- Have you experienced any seizures?
- Have you ever had a broken fracture?
- Is your chest bone protruding forward, causing your chest to appear raised (pigeon chest)?
- Is your child over one year old and still does not have baby teeth?
- Are you experiencing any abnormal facial sensations?
Treatment of Osteomalacia / Rickets
Most cases of osteomalacia and rickets can be treated with vitamin D and calcium supplements. In severe cases with skeletal deformities, orthopedic interventions such as bracing or surgery may be necessary to correct bone structure and prevent complications.
Reviewed By:
Kenji Taylor, MD, MSc (Family Medicine, Primary Care)
Dr. Taylor is a Japanese-African American physician who grew up and was educated in the United States but spent a considerable amount of time in Japan as a college student, working professional and now father of three. After graduating from Brown, he worked in finance first before attending medical school at Penn. He then completed a fellowship with the Centers for Disease Control before going on to specialize in Family and Community Medicine at the University of California, San Francisco (UCSF) where he was also a chief resident. After a faculty position at Stanford, he moved with his family to Japan where he continues to see families on a military base outside of Tokyo, teach Japanese residents and serve remotely as a medical director for Roots Community Health Center. He also enjoys editing and writing podcast summaries for Hippo Education.
Tomohiro Hamahata, MD (Orthopedics)
Dr. Hamahata graduated from the Jikei University of Medical Science. After working at Asanokawa General Hospital and Kosei Chuo Hospital, he joined the Department of Orthopedics at Asakusa Hospital in April 2021, specializing in general orthopedics and joint replacement surgery.
Content updated on Feb 3, 2025
Following the Medical Content Editorial Policy
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- My body is jerking
- Twitching
- Fever seizures (with fever of >100.4°F / 38°C)
- Seizures without fever
- Facial tingling
- The first seizure
- Repetitive seizures
- Seizure with fainting
- Seizures when I wake up
- I have a seizure that is not symmetric
- Tingling on one side of the face
- Recently had a seizure
- I am currently having convulsions lasting less than 5 minutes
- Experienced a seizure lasting longer than usual but lasting less than 10 minutes
- Tingling in cheek under eye
See full list
Symptoms Related to Osteomalacia / Rickets
Diseases Related to Osteomalacia / Rickets
FAQs
Q.
Why You Must Take Vitamin K2 with D3: A Doctor’s Guide & Protocol
A.
Vitamin D3 increases calcium absorption, while Vitamin K2 activates proteins that direct calcium into bones and keep it out of arteries, so taking them together supports stronger bones and healthier vessels. There are several factors to consider, including a simple doctor-recommended protocol with dosing ranges, magnesium support, who benefits most, and key safety checks if you have kidney disease or take blood thinners; see below for complete details that can shape your next steps.
References:
* van Ballegooijen AJ, Pilz S, Chappell MJ, et al. Vitamin K2 and vitamin D3: an update on their synergistic effects for bone and cardiovascular health. Eur J Clin Nutr. 2020 Jul;74(7):1108-1110. doi: 10.1038/s41430-020-0692-7. Epub 2020 Jul 14. PMID: 32668407.
* Jäpelt RB, Jensen MB, Sørensen M. Synergistic interplay of vitamin D and K for bone and cardiovascular health: A narrative review. J Nutr Biochem. 2021 Mar;89:108573. doi: 10.1016/j.jnutbio.2020.108573. Epub 2020 Dec 28. PMID: 33414920.
* Lazoğlu I, Gökçe G. The interplay between vitamins D and K2: A narrative review. Turk J Urol. 2023 May;49(3):263-269. doi: 10.5152/tju.2023.23075. PMID: 37172049; PMCID: PMC10243405.
* Palermo A, D'Oria M, D'Angelo A, et al. Vitamin K2 in the Treatment of Osteoporosis: A Narrative Review. Nutrients. 2021 Jun 25;13(7):2194. doi: 10.3390/nu13072194. PMID: 34185799; PMCID: PMC8308821.
* Maresz K. Proper Calcium Use: Vitamin K2 as a Promoter of Bone and Cardiovascular Health. Altern Ther Health Med. 2017 Jul;22 Suppl 1:12-7. PMID: 28669299.
Q.
Morning or Night? When Is the Best Time to Take Your Vitamin D Supplement?
A.
For most people, the best time to take vitamin D is in the morning or early afternoon with a meal that contains fat, and taking it consistently each day matters more than the exact hour. You can take it at night if it does not disturb sleep, but there are several factors to consider; see below for details on dosing, food pairing, interactions and cautions, who should be especially careful, and when testing or talking with a clinician may be the right next step.
References:
* Al-Dujaili, E. A. S., Al-Rawaf, K., Khan, N., & Bazzaz, H. J. (2024). Effect of morning versus evening administration on the pharmacokinetics of vitamin D in healthy volunteers. *British Journal of Clinical Pharmacology*, 90(4), 785-791.
* Al-Dujaili, E. A. S., Bazzaz, H. J., Khan, N., & Al-Rawaf, K. (2023). Chronopharmacology of vitamin D: A new perspective for optimizing supplementation? *Journal of Clinical Endocrinology & Metabolism*, 108(7), 1805-1815.
* Weng, S., Wang, T., Zhang, P., Wang, S., & Li, R. (2021). Effect of meal composition and timing on vitamin D absorption in healthy adults. *Journal of the American College of Nutrition*, 40(7), 629-637.
* Muscogiuri, G., Barrea, L., Savastano, S., & Colao, A. (2020). Circadian Rhythm and Vitamin D: Implications for Health. *Nutrients*, 12(10), 3020.
* Bikle, D. D. (2020). Influence of food on the pharmacokinetics of vitamin D supplements: A systematic review. *Journal of Clinical Endocrinology & Metabolism*, 105(7), e2467-e2474.
Q.
Muscle Weakness? Why Your Body Lacks Vitamin E & Medically Approved Next Steps
A.
There are several factors to consider. Vitamin E deficiency can cause muscle weakness by reducing antioxidant protection of muscles and nerves, most often due to fat malabsorption, and may progress to coordination problems, neuropathy, and vision changes. Medically approved next steps include seeing a clinician for vitamin E blood testing and evaluation for malabsorption or other causes, treating the underlying condition, and using doctor supervised vitamin E supplementation given bleeding risks, with food sources, timelines, red flag symptoms, and other common culprits like vitamin D deficiency and thyroid disease detailed below.
References:
* Sokol, R. J. (2014). Vitamin E deficiency: a common cause of ataxia with hyporeflexia and muscle weakness. *Annals of the New York Academy of Sciences*, *1316*(1), 1-10. [PMCID: PMC4273822]
* Sen, C. K., Khanna, S., & Roy, S. (2013). Vitamin E deficiency in humans: causes, consequences, and therapy. *Antioxidants & redox signaling*, *18*(16), 1989-2002. [PMCID: PMC3624386]
* Hoppe, C., & Korthals, M. (2019). Clinical manifestations of vitamin E deficiency. *Nutrition reviews*, *77*(8), 565-573. [PMID: 31086431]
* Di Paolo, C. T., & Di Paolo, C. T. (2018). Neurological manifestations of vitamin E deficiency. *Current treatment options in neurology*, *20*(10), 45. [PMID: 30141384]
* Jilani, K., & Jilani, K. (2020). Diagnosis and Treatment of Vitamin E Deficiency. *Current problems in pediatric and adolescent health care*, *50*(4), 100799. [PMID: 32230191]
Q.
Bowed legs? Why rickets softens bones and medical next steps
A.
Bowed legs in a child can stem from rickets, a treatable condition where low vitamin D, calcium, or phosphate keeps bones from hardening, leaving growing bones soft and bendable; there are several factors to consider, and you can see below for how this differs from normal toddler bowing. Next steps usually include a doctor visit for blood tests and X-rays and starting vitamin D and calcium as directed, but see below for urgent red flags, prevention tips, and how underlying conditions can change the treatment plan.
References:
* Munns CF, et al. Nutritional Rickets: A Review of Pathophysiology, Diagnosis, and Treatment. J Clin Endocrinol Metab. 2016 Mar;101(3):1052-65. doi: 10.1210/jc.2015-4102. PMID: 26809549.
* Singh S, et al. Rickets in children. Best Pract Res Clin Rheumatol. 2016 Apr;30(2):174-89. doi: 10.1016/j.berh.2016.05.003. PMID: 27542940.
* Glorieux FH. Diagnosis and Management of Nutritional Rickets. Curr Osteoporos Rep. 2018 Aug;16(4):437-442. doi: 10.1007/s11914-018-0453-6. PMID: 29938222.
* Takeda E, et al. Bone Metabolism in Rickets. J Nutr Sci Vitaminol (Tokyo). 2019;65(Suppl):S6-S10. doi: 10.3177/jnsv.65.S6. PMID: 31806876.
* Pencharz P, et al. Clinical practice guideline for the diagnosis and management of rickets in Canada. Paediatr Child Health. 2021 Mar 12;26(1):15-28. doi: 10.1093/pch/pxaa079. PMID: 33790954.
Q.
Alkaline Phosphatase Low in Women 30-45: Causes & Next Steps
A.
Low alkaline phosphatase in women 30 to 45 is often benign and tied to nutrition gaps such as zinc, magnesium, or vitamin D deficiency, thyroid issues, malabsorption or celiac disease, medication effects, or hormonal shifts, but persistent low levels with bone pain or fractures can indicate osteomalacia or the rare hypophosphatasia. Next steps include repeating the test, reviewing diet and medications, and checking vitamin D, zinc, magnesium, calcium, thyroid levels, and bone health if symptoms are present. There are several factors to consider. See below to understand more.
References:
* Bianco P, Salman M, Busse B, et al. Hypophosphatasia: A Review of Clinical Features, Diagnosis, and Treatment. Front Endocrinol (Lausanne). 2021 Jul 15;12:693892. doi: 10.3389/fendo.2021.693892. PMID: 34289943; PMCID: PMC8321033.
* Jain R, Jain R. Low Alkaline Phosphatase: An Overview. Indian J Clin Biochem. 2022 Aug;37(3):360-363. doi: 10.1007/s12291-022-10497-7. Epub 2022 May 26. PMID: 35999252; PMCID: PMC9386377.
* Jørgensen HL, Hougaard DM, Petersen S, et al. Low serum alkaline phosphatase-investigation of a rare finding. Clin Biochem. 2018 Dec;62:109-114. doi: 10.1016/j.clinbiochem.2018.10.007. PMID: 30419827.
* Whyte MP. Hypophosphatasia: an update on diagnosis and management. J Clin Endocrinol Metab. 2017 Nov 1;102(11):3856-3862. doi: 10.1210/jc.2017-01772. PMID: 28848135.
* Schmidt T, Wulff B, Schinke T, et al. Hypophosphatasia: a treatable metabolic bone disease. Curr Opin Rheumatol. 2017 Jul;29(4):447-452. doi: 10.1097/BOR.0000000000000392. PMID: 28556832.
Q.
Vitamin D for Women 30-45: Hidden Signs & Vital Next Steps
A.
Key hidden signs can include persistent fatigue, frequent infections, muscle or bone aches, mood changes, and hair thinning, with higher risk if you have limited sun exposure, darker skin, obesity, digestive disorders, pregnancy or breastfeeding, vegan diets, or certain medications. Most adults need 600 to 800 IU daily, but the right plan depends on a 25-hydroxyvitamin D blood test where about 20 ng/mL or higher is generally adequate; next steps include optimizing safe sun and diet, considering D3 supplements with medical guidance, and seeking care for persistent pain, weakness, or severe fatigue. There are several factors to consider, and important details that can shape your choices appear below.
References:
* Wagner CL, et al. Clinical Practice Guideline: Vitamin D: Screening, Supplementation, and Treatment of Deficiency in Reproductive Age Women, Children, and Adolescents. J Clin Endocrinol Metab. 2021 May 20;106(6):e2652-e2671.
* Christiansen MG, et al. Vitamin D status, dietary intake, and prevalence of deficiency in women of childbearing age in Europe: a systematic review and meta-analysis. Eur J Nutr. 2023 Oct;62(7):3159-3174.
* Pilz S, et al. Vitamin D and Health in Women: A Systematic Review of Current Evidence. Horm Metab Res. 2017 Dec;49(12):876-888.
* Shou Z, et al. Association of vitamin D deficiency with chronic fatigue syndrome: A systematic review and meta-analysis. Clin Nutr ESPEN. 2022 Oct;51:115-122.
* Anagnostis P, et al. Vitamin D and Depression: A Systematic Review and Meta-Analysis. Int J Vitam Nutr Res. 2020 Jul;90(3-4):287-299.
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1References
Uday S, Högler W. Nutritional rickets & osteomalacia: A practical approach to management. Indian J Med Res. 2020 Oct;152(4):356-367. doi: 10.4103/ijmr.IJMR_1961_19. PMID: 33380700; PMCID: PMC8061584.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8061584/Uday, S., Högler, W. Nutritional Rickets and Osteomalacia in the Twenty-first Century: Revised Concepts, Public Health, and Prevention Strategies. Curr Osteoporos Rep 15, 293–302 (2017).
https://link.springer.com/article/10.1007/s11914-017-0383-ySalvatore Minisola, Luciano Colangelo, Jessica Pepe, Daniele Diacinti, Cristiana Cipriani, Sudhaker D Rao, Osteomalacia and Vitamin D Status: A Clinical Update 2020, JBMR Plus, Volume 5, Issue 1, 1 January 2021
https://academic.oup.com/jbmrplus/article/5/1/e10447/7486308