Osteomalacia Vs. Osteoporosis: Key Differences

Osteomalacia and osteoporosis are both conditions that affect the bones. While both are diseases that cause a person’s bones to weaken, they are distinct from each other.

Knowing how they differ is important as you will be likely to get the appropriate medical intervention. We discuss the key differences between these bone conditions in several areas.

What is osteomalacia?

Osteomalacia is a condition that stops a person’s bones from mineralising (or hardening) as they normally would. This results in ‘soft bones’ that are weak, as bones break down faster than they are formed. Thus, people with osteomalacia have bones that are more likely to break and/or bend.

Osteomalacia in children is called rickets.

What are the symptoms of osteomalacia?

Common signs and symptoms of osteomalacia include:

  • Pain in the hips and bones
  • Difficulty walking - you may notice a side-to-side waddling stride
  • Difficulty getting up from sitting position
  • Stiffness
  • Muscle weakness, especially in arms and thighs
  • Bones that break easily

What are the causes of osteomalacia?

Osteomalacia is generally caused by a Vitamin D deficiency. One of the main functions of Vitamin D is to help our bodies absorb the calcium we get from food or supplements. Hence their importance in bone health and the reason a lack of Vitamin D can lead to bone issues.

A Vitamin D deficiency can result from:

  • Intestinal issues
  • Diet issues
  • Lack of exposure to sunlight

People with the following health conditions might also have issues absorbing Vitamin D:

  • Celiac disease
  • Kidney disorders
  • Liver disorder
  • Certain types of cancer

What is osteoporosis?

Osteoporosis refers to a condition where bone mass and bone density decreases. This causes changes in the bone structures and reduces bone quality.

Our bones usually have spaces that look like a honeycomb structure. These spaces become much larger for people who have osteoporosis. As a result, bone strength decreases, and the risk of fractures increases.

What are the symptoms of osteoporosis?

Unfortunately, osteoporosis does not present with any symptoms. It can be undetected for years, and as such, is sometimes referred to as a ‘silent’ disease. Many people who have osteoporosis only realise they have it after breaking or fracturing a bone.

Nonetheless, there are a few symptoms that may signify that you have this bone disease:

  • Loss of height - getting shorter by a few inches
  • Change in posture - bending forward or stooping
  • Shortness of breath - due to compressed disks that reduce lung capacity
  • Lower back pain

What are the risk factors of osteoporosis?

The cause of osteoporosis is unclear, but there are certain risk factors pertaining to this condition.

Osteoporosis risk factors include:

  • Age - your bones naturally weaken as you age
  • Menopause - the change in hormone levels can result in quicker bone loss
  • Family history of osteoporosis
  • Poor diet and lack of nutrition
  • An inactive lifestyle contributes to bone loss
  • Certain medical conditions and medicines, such as:
    • Overactive thyroid
    • Celiac disease
    • Inflammatory bowel disease (IBD)
    • Blood diseases like multiple myeloma
  • History of weight loss surgery
  • Hormone treatments for prostate or breast cancer
  • Long-term steroid use (prednisone)

Besides this, genetics, gender, and ethnicity also play a role in bone mass. The Bone Health and Osteoporosis Foundation reports that this disease is more likely to occur in women, especially with a higher prevalence in Asian and white women.

How are osteomalacia and osteoporosis diagnosed?

The diagnosis for osteomalacia and osteoporosis differs in some ways.

Osteomalacia diagnosis

A blood test to measure vitamin D, calcium, and phosphorus levels is usually sufficient to diagnose osteomalacia.

Additionally, your doctor might also check for alkaline phosphatase, which is produced by bone-making cells. Alkaline phosphatase levels are usually elevated in people who have osteomalacia.

Parathyroid hormone which is a sign of vitamin D deficiency.

An X-ray to check for small fractures or cracks in the bones may also be ordered.

Osteoporosis diagnosis

Osteoporosis often does not present with any symptoms in the beginning, routine screening for the condition is needed. This is especially for women over 65 or who have the above-mentioned risk factors.

Diagnostic tools for osteoporosis include:

  • Medical history, such as previous fractures, family history of osteoporosis, and lifestyle choices
  • Physical examination to check muscle strength, balance, and gait
  • Bone mineral density testing such as a DXA scan

Can you have both osteomalacia and osteoporosis?

Yes, it is possible to have both of these bone conditions. A 2014 study found that 70% of people with osteomalacia had a low bone density that could actually be classified as osteoporosis. As such, it’s vital to differentiate between secondary and primary osteoporosis so that appropriate and effective treatment can be prescribed.

What are the treatment options for osteomalacia and osteoporosis?

Treatment for these two conditions also differs.

Osteomalacia treatments

If detected early, vitamin D, calcium, and phosphate supplements might be recommended. Intravenous Vitamin D may also be given.

If an underlying medical issue is affecting your body’s vitamin D absorption, then the health condition needs to be treated as well.

Children with osteomalacia may need surgery if there are bone abnormalities or wear braces to support their bodies and prevent falls that may result in bones breaking or fracturing.

Osteoporosis treatments

Osteoporosis treatments aim to slow or stop bone loss and prevent fractures. Treatment may include:

  • Nutritional changes to up vitamin D, calcium, and protein intake
  • Lifestyle changes such as reducing alcohol, stopping smoking, and getting regular check-ups
  • Exercising, with a focus on strength and resistance training. This would include exercises that your therapist has recommended
  • Medication to strengthen bones and prevent or slow further bone loss

Talk to an occupational therapist about fall prevention strategies.

Can osteomalacia and osteoporosis be prevented?

To prevent vitamin D deficiency osteomalacia, you can increase vitamin D intake with foods such as oily fish, egg whites, fortified cereals, yoghurt, milk, and bread. You can also consider taking supplements.

However, if osteomalacia is caused by an underlying medical condition, you will need to treat the underlying medical issue.

To reduce the risk of osteoporosis, ensure that you:

  • Eat a balanced diet
  • Get adequate calcium and vitamin D
  • Eat food that will boost bone health, such as fruits and vegetables
  • Limit alcohol intake
  • Consider quitting smoking

Book an appointment at Pantai Hospitals

Because bone conditions can be dangerous if not treated, it is best to speak to a doctor if you are at risk of osteomalacia or osteoporosis for an early and accurate diagnosis, as well as an appropriate and personalised treatment plan.

If you or a loved one is experiencing physical pain or discomfort due to a possible orthopaedic disorder, get in touch with us for an appointment with an Orthopaedic specialist your nearest Pantai Hospital.

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.


Bone Health and Osteoporosis Foundation (2022) What Women Need To Know, Available at https://www.bonehealthandosteoporosis.org/preventing-fractures/general-facts/what-women-need-to-know/ [Accessed 18 Feb 2022]

D.B. Morgan (1 August 1968) Osteomalacia and Osteoporosis, Available at https://pmj.bmj.com/content/postgradmedj/44/514/621.full.pdf [Accessed 18 Feb 2022]

Healthline (19 May 2021) Osteomalacia vs. Osteoporosis: What’s the Difference? Available at https://www.healthline.com/health/managing-osteoporosis/osteomalacia-vs-osteoporosis [Accessed 28 Feb 2022]

Massoud Saghafi, Azita Azarian, Kamila Hashemzadeh, Maryam Sahebari, Zahra Rezaieyazdi (4 Feb 2014) Bone densitometry in patients with osteomalacia: Is it valuable, Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3917579/ [Accessed 28 Feb 2022]

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