Adult Rickets Is Usually a Sign of Something Else

Rickets is often thought of as a childhood disease causing soft, weak bones. But adults can develop a very similar condition, more accurately called osteomalacia. When adults show signs of rickets, it usually points to an underlying health issue that needs attention.

Can adults get rickets?

Yes. In adults, rickets is known as osteomalacia. It results from poor bone mineralization due to low levels of vitamin D, calcium or phosphate. Unlike children—whose growing bones lead to bowed legs—adults typically experience diffuse bone pain, muscle weakness and a higher risk of fractures.

Why adult “rickets” matters

Adult osteomalacia is not a disease in itself but a sign that something else is wrong. Common causes include:

• Vitamin D deficiency
• Calcium or phosphate imbalance
• Kidney or liver disease
• Gastrointestinal malabsorption
• Certain medications (e.g., anticonvulsants, antiretrovirals)

Identifying and correcting the root cause is critical. Without treatment, bone pain may worsen, fractures can occur with minimal trauma, and overall quality of life can decline.

How bones normally stay strong

Bones constantly remodel—old bone breaks down and new bone forms. For new bone to harden, it needs:

• Vitamin D (helps absorb calcium and phosphate)
• Calcium (primary mineral in bone)
• Phosphate (works with calcium to build bone)

If any part of this system fails, bones lose density and become soft.

Common reasons for adult osteomalacia
--------------------------------------+

1. Vitamin D deficiency
   • Inadequate sun exposure (especially in higher latitudes or with extensive sunscreen use)
   • Diets very low in fatty fish, fortified dairy or eggs
   • Darker skin (more melanin reduces vitamin D synthesis)
2. Malabsorption syndromes
   • Celiac disease, Crohn’s disease, ulcerative colitis
   • Bariatric surgery (reduces absorption surface)
3. Kidney or liver disease
   • Kidneys convert vitamin D to its active form; liver stores and modifies vitamin D precursors
4. Medications
   • Anticonvulsants (e.g., phenytoin, phenobarbital)
   • Antiretroviral drugs (for HIV)
   • Long-term steroids
5. Rare genetic or metabolic disorders
   • X-linked hypophosphatemia
   • Tumor-induced osteomalacia (certain tumors produce factors that lower phosphate)

Signs and symptoms to watch for

Often gradual in onset, adult osteomalacia may cause:

• Dull, aching bone pain (hips, lower back, legs)
• Muscle weakness or cramps
• Difficulty walking or waddling gait
• Frequent “stress” fractures (ribs, spine, legs)
• Dental problems (soft enamel, delayed tooth formation)
• Numbness or tingling in hands and feet (in severe cases)

Because symptoms resemble other conditions (arthritis, fibromyalgia), osteomalacia can be overlooked. If you’ve had persistent bone pain or weakness, consider a free, online symptom check, using the doctor approved Ubie Symptom Checker.

How doctors diagnose adult rickets (osteomalacia)

A thorough evaluation includes:

1. Medical history and physical exam
   • Dietary habits, sun exposure, medication review
   • Bone tenderness or muscle weakness tests
2. Blood tests
   • 25-hydroxyvitamin D (best measure of vitamin D status)
   • Calcium and phosphate levels
   • Alkaline phosphatase (often elevated with bone turnover)
   • Parathyroid hormone (PTH)
3. Urine tests
   • Calcium and phosphate excretion
4. Imaging studies
   • X-rays may show Looser’s zones (pseudo-fractures)
   • Dual-energy X-ray absorptiometry (DEXA) for bone density
5. Specialized tests (if needed)
   • Bone biopsy (rarely)
   • Genetic testing or tumor search in complex cases

Treatment focuses on correcting deficiencies and addressing the root cause.

Treatment and management

1. Nutritional supplementation
   • Vitamin D3 (cholecalciferol) or D2 (ergocalciferol) as prescribed
   • Calcium supplements (if dietary intake is insufficient)
   • Phosphate supplements (in certain disorders)
2. Diet and lifestyle
   • Increase fatty fish (salmon, mackerel), fortified dairy, eggs
   • Moderate sun exposure (10–30 minutes, arms and legs uncovered, 2–3 times weekly)
   • Weight-bearing exercises to strengthen bones
3. Treat underlying conditions
   • Gluten-free diet for celiac disease
   • Medication review and adjustment
   • Manage kidney or liver disease in collaboration with specialists
4. Follow-up monitoring
   • Repeat blood tests to gauge response
   • Periodic imaging if fractures were present

Most people respond well over weeks to months. Bone pain improves, muscle strength returns, and blood values normalize.

Preventing adult osteomalacia

• Aim for daily vitamin D intake of 600–800 IU (higher if risk factors exist)
• Consume calcium-rich foods (1,000–1,200 mg/day)
• Get sensible sun exposure, balancing skin cancer risk
• Review medications with your healthcare provider
• Check bone health if you have malabsorption, liver or kidney issues

When to seek medical help

Although adult osteomalacia develops slowly, prompt attention reduces complications. See a doctor if you experience:

• Persistent bone pain or deep aching
• Unexplained muscle weakness
• Frequent fractures with minimal trauma
• Numbness or tingling in hands or feet
• Any symptom that interferes with daily life

If you’re unsure what’s causing your symptoms, try a free, online symptom check, using the doctor approved Ubie Symptom Checker. It may help you decide which tests to discuss with your healthcare provider.

Speak to a doctor about serious concerns

This information is for educational purposes and does not replace professional medical advice. If you experience severe pain, sudden weakness, or signs of a fracture (swelling, inability to bear weight), seek medical care immediately. Always talk to a doctor before starting supplements or making significant lifestyle changes.

Key takeaways

• Yes, adults can get “rickets,” but it’s called osteomalacia.
• It signals a deeper issue: vitamin D, calcium or phosphate imbalance, malabsorption, organ disease or medications.
• Symptoms include bone pain, muscle weakness, fractures and dental problems.
• Diagnosis relies on labs, imaging and a careful medical history.
• Treatment corrects deficiencies, addresses root causes and emphasizes diet and lifestyle.
• Prevention involves balanced nutrition, safe sun exposure and regular check-ups.
• Use a tool like the Ubie Symptom Checker to guide your next steps—and speak to a doctor about anything serious or life-threatening.