Can Adults Develop Rickets? Understanding Adult-Onset Rickets

Rickets is often thought of as a childhood disease marked by soft, weak bones and bowed legs. In adults, the counterpart of rickets is called osteomalacia—but the process and risks can be similar. When adults develop symptoms akin to rickets, it’s sometimes referred to as adult-onset rickets. Though rare in well-nourished populations, adult-onset rickets can arise if bone mineralization remains inadequate.

Below, we explain causes, symptoms, diagnosis, treatment and prevention of adult‐onset rickets in clear, concise terms. If you’re concerned about your health, consider a free, online symptom check, using the doctor approved Ubie Symptom Checker and always speak to a doctor about any serious or life-threatening issues.

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What Is Adult-Onset Rickets?

• Rickets typically refers to impaired bone mineralization in growing children.
• In adults, the same lack of mineralization is called osteomalacia, but it can present similarly.
• Adult-onset rickets is not a separate disease, but a descriptive term for bone-softening conditions in adults.

The key issue is inadequate deposition of calcium and phosphate in the bone matrix, leading to bone pain, fractures and muscle weakness.

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Common Causes of Adult-Onset Rickets

Adult-onset rickets (osteomalacia) can result from various factors that impair vitamin D levels or bone mineralization:

1. Insufficient Vitamin D Intake or Synthesis

   • Low dietary vitamin D (found in fatty fish or fortified foods)
   • Limited sun exposure (e.g., indoor lifestyles, high-latitude living)
   • Use of sunscreen or clothing that blocks UVB rays

2. Malabsorption Syndromes

   • Celiac disease, Crohn’s disease or other conditions affecting the gut lining
   • Bypass surgery for obesity can reduce absorption of vitamin D and calcium

3. Chronic Kidney or Liver Disease

   • Kidneys convert vitamin D to its active form; impaired function leads to deficiency
   • Liver disease can reduce production of proteins needed to transport vitamin D

4. Medications

   • Anticonvulsants (e.g., phenytoin, phenobarbital) accelerate vitamin D breakdown
   • Some antifungal drugs and certain HIV therapies have a similar effect

5. Hormonal Disorders

   • Low parathyroid hormone (hypoparathyroidism) disrupts calcium regulation
   • High levels of parathyroid hormone (secondary hyperparathyroidism) can result from low calcium intake

6. Phosphate Loss

   • Genetic disorders affecting phosphate handling (e.g., X-linked hypophosphatemia)
   • Excessive use of phosphate-binding antacids

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Signs and Symptoms

Adult-onset rickets often begins subtly and progresses over months:

• Bone Pain

  • Dull, aching pain in the hips, lower back, ribs or legs
  • Often worsens with movement or weight bearing

• Muscle Weakness

  • Difficulty climbing stairs or rising from a chair
  • Feeling of heaviness in thighs or shoulders

• Fractures

  • Stress fractures in the hips, ribs or long bones with minimal trauma
  • Slow healing of any fractures

• Postural Changes

  • Pelvic tilt leading to a waddling gait
  • Kyphosis (rounded upper back) in severe cases

• Dental Issues (less common in adults)

  • Delayed tooth eruption or cavities if vitamin D deficiency has been long-standing

Because these symptoms overlap with osteoporosis and other bone disorders, proper evaluation is essential.

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Diagnosis

A thorough assessment includes:

1. Medical History & Physical Exam

   • Diet, lifestyle, sun exposure, medications and family history
   • Examination of muscle strength, posture and bone tenderness

2. Laboratory Tests

   • Serum calcium, phosphate and alkaline phosphatase levels
   • 25-hydroxyvitamin D (the best indicator of vitamin D status)
   • Parathyroid hormone (PTH) levels

3. Imaging Studies

   • X-rays may show Looser’s zones (pseudofractures)
   • Bone density scans (DEXA) to assess overall bone mass

4. Specialized Tests (if needed)

   • Kidney and liver function panels
   • Tests for celiac disease or other malabsorption causes

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Treatment Strategies

The primary goal is to restore normal bone mineralization by correcting deficiencies and addressing underlying causes.

1. Vitamin D and Calcium Supplementation

   • High-dose vitamin D (cholecalciferol or ergocalciferol) under medical supervision
   • Calcium carbonate or calcium citrate to reach 1,000–1,200 mg elemental calcium daily

2. Treat Underlying Conditions

   • Improve gut absorption for those with malabsorption syndromes
   • Adjust or substitute medications that interfere with vitamin D metabolism
   • Manage chronic kidney or liver disease in collaboration with specialists

3. Monitor Response

   • Repeat blood tests every 3–6 months to ensure normalization of calcium, phosphate and vitamin D
   • Follow-up imaging if fractures or severe bone pain persist

4. Physical Activity

   • Gentle weight-bearing and muscle-strengthening exercises
   • Physical therapy to restore normal gait and posture

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Preventing Adult-Onset Rickets

Simple lifestyle and dietary changes can reduce risk:

• Spend 10–30 minutes in midday sun several times a week (adjust for skin tone and latitude).
• Include vitamin D–rich foods:
  • Fatty fish (salmon, mackerel, tuna)
  • Fortified milk, orange juice or cereals
• Ensure adequate calcium intake through dairy products or fortified alternatives.
• Discuss vitamin D supplementation with your healthcare provider, especially if you have risk factors.

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When to Seek Medical Advice

While mild vitamin D insufficiency may cause only fatigue or muscle aches, adult-onset rickets can lead to serious complications if untreated.

Seek immediate medical attention if you experience:

• Sudden, severe bone pain or multiple fractures after minor trauma
• Marked muscle weakness that impairs daily activities
• Signs of dehydration or kidney problems (e.g., dark urine, reduced urination)

For ongoing concerns—such as persistent bone pain or difficulty walking—consider a free, online symptom check, using the doctor approved Ubie Symptom Checker to guide your next steps.

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Final Thoughts

Adult-onset rickets (osteomalacia) is uncommon in many parts of the world, but it can develop under the right conditions of vitamin D and mineral deficiency. Early recognition and treatment restore bone health and prevent fractures. If you suspect you have symptoms suggestive of adult-onset rickets, speak to a doctor promptly. Only a qualified healthcare professional can diagnose, treat and monitor this potentially serious condition.